Electronic Journal of Human Sexuality, Volume 3,
Feb. 1, 2000

www.ejhs.org

CHILD SEXUAL DEVELOPMENT

Loretta Haroian, Ph.D.

Editor's Note: The late Dr. Haroian was a Professor at the Institute
for Advanced Study of Human Sexuality for many years. This monograph was
prepared for student use in the mid-1980's, and has been a part of the
education of many sexologists. It is time it was made available to the
general public, and the many teachers of sexuality education to our young
people. The references to DSM-III are a bit outdated, but the information
is still useful.

David Hall, Ph.D.Editor

PART I

Sexual Health

Sexual health is more than the absence of sexual pathology. The anatomy,
gender and function of the human body is the foundation of identity. The
awareness of the sexual self as an integrated aspect of identity begins
in infancy with the attitudes about the physical body communicated by the
caretakers.

The sexual response cycle as described by William Masters, M.D. and
Virginia Johnson, M.A., is present at birth, and there is evidence that
the neurological maturation necessary to produce penile erections occurs
in utero. The development and expression of the erotic response throughout
the human lifespan is not a well studied phenomenon, and normative data
have not been compiled for sexual behaviors of childhood and adolescence.
As we know it, the erotic response consists of a complex interplay of physiological
and psychological factors that are highly susceptible to familial, religious
and cultural folkways, mores and attitudes. The styles of acceptable sexual
attitude and expression fluctuate historically and culturally between generally
positive and generally negative polarities. At this time, our own restrictive
culture time is still preoccupied with imposing sexual constraints rather
than promoting sexual competencies as a basic value system. We are certainly
less zealous in this pursuit than the repressive Victorians, but fears
of sexual excess and pleasure leading to a fall from grace are deeply imbedded
in the Judeo-Christian ethic. The impacts of this often unconscious attitude
on child rearing are the overt and/or covert discouragement of sexual interest,
curiosity, expression and sexual behavior of children in the presence of
adults and the continual obfuscation of the scientific answer to the question
“What is normal?”

Sexually permissive cultures not only allow a less fettered
expression of adult sexuality, but may give little attention to the sexual
behaviors of children as long as they are not blatantly displayed. Sexually
supportive
cultures, believing that sex is indispensable to human happiness, encourage
early sexual expression as a means of developing adult sexual competency
and positive sexual attitudes. The children in sexually permissive and
sexually supportive societies display a similar developmental pattern that
is not apparent in sexually restrictive and sexually repressive
societies:

In infancy,
there is usually manual and oral genital stimulation of children of both
sexes by parents as a means of comforting and pacifying them (most frequently
between mothers and sons).

In early childhood,
masturbation alone and in groups, leads to exploration and experimentation
among children of same and opposite gender.

Late childhood
(prepubescent) is characterized by heterosexual role modeling and attempted
intercourse (girls may begin having regular coitus with older boys).

In pubescence,
girls rapidly accelerate into a phase of intense sexual experience, culminating
in the acquisition of basic sexual techniques at the adult level. Boys
follow a similar pattern, but their learning process is not as rapid or
complete because they are usually experimenting with younger girls. Heterosexual
patterns replace masturbation and homosexual activities for the majority
of both boys and girls.

In adolescence,
there is increased sexual activity with peers and adults for both boys
and girls; and it is believed that birth control is facilitated by the
practice of multiple partners. Marriage is common for late adolescent girls,
but boys may delay marriage for economic considerations and continue their
adolescent sex patterns for longer periods (Ford and Beach, 1951)

History

It would appear that human sexual expression follows a logical, orderly
and self regulating developmental pattern in much the same way as other
aspects of human behavior and that psychosexual disorders may be the result
of the interruptions of that sequential growth process. It is well to remember
that prior to the Victorian idealization of childhood innocence, children
were commonly used and abused physically and psychologically. Eighteenth
century aristocratic tradition imposed a barrier between parent and child.
It was the height of bad taste to love one's spouse and children, as parenthood
was thought to render both men and women less fit for amorous adventure.
Infants were removed from their parents and suckled by wet nurses; mortality
was high, even for children who were well cared for. Infanticide was the
major method of population control, and infants were abandoned, neglected
and intentionally killed by drowning, burning, scalding, potting and overlaying.
Those who survived were often maimed or crippled to make them more poignant
beggars and were at the mercy of unscrupulous and exploitive adults. Sexual
exploitation of children was freely indulged in until the latter half of
the 18th century, at which time it was fully repudiated. This was a decisive
turning point in parent child relationships in that parents began to punish
children for their sexual curiosity and activity (DeMause, 1974).

The Victorian era was a period of sexual schizophrenia for children.
The cultural dictum that childhood was free of, and was to remain free
from, sexual knowledge, interest and behavior, was contradicted by a constant
and continual adult preoccupation with, and surveillance of, children's
sexual potential. Freud's attempt to bring some sanity into this schizophenogenic
bind was theoretically helpful; however, the sadistic trend in anti-masturbatory
therapy accelerated when people became aware of infant sexuality (Spitz,
1952).

The repression of sexuality made any expectation of sexual health improbable,
if not impossible, to achieve. It produced a pervasive negative preoccupation
with the sexuality of others and a category of emotional disorders labeled
“psychosexual.” In keeping with the contradictions of the time, the sexual
referent to all nonsexual symptomatology was diligently searched for or
speculated about; and direct treatment of sexual symptoms was bypassed
in favor of analyzing the “psychosexual” stages of childhood development.
Although the expectation of both therapist and patient was that healthy
sexual function would be restored by the exploration of the parent-child
bonding relationship, this was rarely, if ever, the result of psychoanalysis.

Sexology

The mental health community continues to have a poorly defined concept
of sexual health and is in fact only called upon to attend those who have
experienced sexual trauma, dysfunction and/or sexual pathology. Although
sexuality (i.e. sexual interest, sex drive) is considered by many to be
the life force, sexology (sexual science) is less than 100 years old. Clinical
sexology (the diagnosis and treatment of sexual concerns and dysfunctions)
as a specialty is newer still. Sex therapy has been a viable and identifiable
health specialty since the 1960s, and the clinical sexologist is a phenomena
of the late 1970s. However, the clinical child sexologist is a professional
category of the future. Even so, pediatric professionals in both medicine
and mental health are consulted by parents, caretakers, authorities and
occasionally, youth themselves about sexual matters. It is no longer questionable
to consider sexual health as the absence of sexual pathology, because sexual
pathology is often a religious-cultural definition which fails to consider
the broad range of human sexual activity and its developmental aspects
and measurable frequencies, as well as its impact on the quality of human
life.

Sexual Rights of Children

In the western culture, great controversy has been perpetuated over
what adult (parent and professional) attitudes about children's sexual
expression should be. Many child rights advocates believe that children
are a disenfranchised minority in the age/class system and state that the
privilege and responsibility of sexual behavior is one of the many human
rights denied them. They suggest that the proper adult stance is one of
permissiveness to encouragement (Farson, 1974; Yates, 1978). This argument
is more than vaguely akin to the rhetoric of the pedophile groups who have
a vested interest in the relaxation or abolishment of child protective
(albeit restrictive) laws. Many child experts more conversant with the
vulnerabilities of children in a complex pluralistic society opt for laws
and social custom that, although somewhat limiting, provide protection
from unscrupulous adults. Children, by definition, are not consenting adults
in sexual matters and may need protection from the liability of sexual
contracts in the same manner that they are not held accountable for business
or labor contracts.

This position does not suggest that there is inherent harm in sexual
expression in childhood; in fact, we have considerable evidence to the
contrary. Sexologically, it is based on the knowledge that the benefits
of free sexual expression of children can only occur in a sexually supportive
society: a society in which all people have sex for sexual reasons, one
in which sexual knowledge, skill and pleasure are valued for both males
and females. A society that encourages sexual competency rather than constraint
and in which every man, woman and child can say “yes” or “no” to sex without
prejudice or coercion. To encourage children to be sexual in a sexually
repressive or permissive/ambivalent culture is to exploit their healthy
sexual interest, as they will be left alone to deal with a double standard
and the sex-negative, self-serving attitudes of peers and adults.

PART II

Development of the Erotic Response

In the absence of normative data on the behavioral manifestations of
the development of the erotic response from birth through adolescence,
we must, for the moment at least, hypothesize a normal distribution of
an infinitive population. We assume then that there will be some highly
sexed children for whom sexual concerns and sexual expression will be a
dominant theme, positively or negatively expressed in their life as a whole,
with some fluctuation in the various stages of development and in response
to certain circumstances. There will be a like number of children for whom
sexual concerns and expression are a consistently low priority in the organization
of their life as a whole, with some fluctuations in the various stages
of development and in response to certain life events. The middle 68% is
hypothesized to fall equally distributed between these two extremes and
to have a moderate focus on the sexual aspects of human existence with
the aforementioned fluctuations. This group would be more responsive to
the external cultural attitudes about sexuality and would be more easily
influenced by external events (i.e., they would be more liberal in sexually
permissive times or cultures and more conservative in sexually restrictive
times or cultures).

With the normal distribution of the population as a theoretical baseline,
it would appear that a wholesale advocacy of more sexual expression in
childhood would be as oppressive to the children at one end of the distribution,
as a societal expectation of no sexual expression in childhood would be
to the children at the other end of the continuum. It is a romantic notion
that the encouragement of sexual freedom in childhood would produce a society
of adults who rise to unparalleled heights of sexual intimacy and ecstasy
and who are devoid of sexual dysfunction. If we can hypothesize the normal
distribution of sexual interest and drive, can we also project the fluctuations
that are subject to age, stage and life events? A close look at the developmental
and sociological literature allows for some cautious extrapolation. Keeping
in mind that developmental criteria for normative age and stage behavior
are, to a degree, culture-bound, we can project some reasonable parameters
of expected sexual behavior.

Overview

There are four stages of childhood and adolescence in which the focus
of the body shifts between a primary and a secondary concern. The first
stage is from birth to approximately 6 years of age. The physical
body is primary; and sexual interests, curiosity, arousal and behavior
are spontaneously expressed unless or until the child is taught to repress
or inhibit her/his pleasure orientation.

The second stage is from approximately age 6 to pubescence
(approximately age 12). The physical growth ratio slows, the basic gross
and fine motor coordination is accomplished and reliable and the primary
attention of the child shifts to the mental realm. The desire for sexual
pleasure continues; however, most children are thoughtful and discriminating
about their sexual
behavior and expressions. Their needs for privacy and autonomy characterize
this stage.

The third stage is pubescence to early adolescence, and
the age range is highly variable: approximately ages 13 to 15. As the hormones
come into play, the body is once again primary, with rapid growth spurts,
the development of secondary sex characteristics, sensations of increased
intensity and a new awareness of the physical self and its impact on others
in the social sense. Sexual behaviors respond to a stronger biological
mandate, becoming a preoccupation which may be characterized by poor social
judgment, high risk behavior and lack of discrimination.

The fourth stage is mid to late adolescence; and again,
the age range is variable: approximately age 16+. The body growth rate
slows,, the hormonal balance is achieved, the secondary sex changes are
incorporated into the body image, the sexual response cycle is accommodated
through masturbation or partner sex and sexual gratification is integrated
into the context of a relationship.

The sexual maturation of a child reflects the overall pattern of development,
from absorption in and dependency on the family of origin through the gradual
acquisition of a sense of the autonomous self, to the confidence and desire
to establish an intimate bond and form the family of choice. The erotic
response of infancy is global, undifferentiated and polymorphously perverse.
In childhood, it moves toward a genital focus (more surely for boys than
for girls) and is expressed through purposefully directed masturbatory
activity and perhaps some negotiated social interaction (often with same
sex partners). At pubescence, the genital focus intensifies, the acquisition
of opposite sex partners gains importance for heterosexual youth and sexual
experience per se is the paramount goal. In adolescence, this motivation
of curiosity and self gratification emerges into one of sexual reciprocity
and mutual sharing. Partnerships are increasingly stable, interdependent
and emotionally intimate. It is well to note that this developmental schema
appears to be stable in all cultures, whether they be sexually repressive,
restrictive, permissive or supportive; however, it is enhanced by, but
not dependent on, the child's ability to engage in sexual behavior and
is seen as a mental construct in the absence of sexual experimentation.
There is considerable evidence that adult sexual health and pleasure are
positively correlated with age appropriate childhood sexual behavior. The
interplay between the individual sex drive, importance of sex in a person's
life and the sexual values of the culture (sex-negative or sex-positive
messages) will determine the opportunity for sexual behavior in childhood
and adolescence. The strongly sexed child may struggle through what constitutes
a repressive childhood in a sexually negative culture, but emerge as a
sexually healthy adult because s/he took every possible opportunity to
be sexual and maintained a positive sexual focus despite censure and sanction
(typically a male pattern). More at risk in our culture is the moderately
sexed child or low sexed child who accepts the culturally negative values,
is sexually inactive and unaware during childhood and finds him/herself
out of phase with the sexual expectations of adulthood (typically female
pattern).

Although it is currently popular to attribute all sex specific differences
to cultural factors, it may well be that there are inherent differences;
these constitute a major child rearing concern. A close look at American
child rearing practices suggests that in terms of adult attitudes, boys
exist in a heterosexually permissive culture. There is some expectation
that “boys will be boys,” which includes sexual experimentation and behavior;
and as long as they do not blatantly flaunt their sexual interest and activities
in front of adults, they receive little censure. Girls, on the other hand,
are reared in what is essentially a sexually restrictive society in that
their sexual interest, and certainly sexual behavior, is neither sanctioned
nor ignored by adults.

Conversely, girls are expected to be nonsexual in childhood and adolescence.
Sexual interest, curiosity and, especially, sexual experience cause girls
to be devalued by family and peer group alike. Sexual innocence, inexperience
and ignorance are cultural values for girls. They are permitted to express
curiosity and receive information about their future reproductive function
as their gender role is programmed. Sexual intercourse is presented as
the gift they are to give the man they love--a marital duty, necessary
for impregnation. They might, on occasion, enjoy it, but the pleasure aspect
is reportedly dependent on love and is not considered sufficient reason
for their engaging in sex. (Men have sex because they love sex, women have
sex because they love the man). Girls are taught to withhold and begin
to use their sexuality as a negotiable commodity. Concurrently, they are
taught to devalue women who sell their sexuality, the prostitute being
held out as the greatest threat to the sanctity of female virtue and family
values. Girls are expected to be the guardians of cultural mores by restricting
or diverting the male sex drive.

Boys are taught that it is their nature and their right to pursue sexual
gratification, but that girls who, like themselves, seek sexual experience
and pleasure, are less valued in society than girls who deny them sexual
favors. Boys may be more egalitarian in their attitudes about their “sexual
partner,” expecting her to be uninhibited, willing and responsive. Although
they appreciate and enjoy sex with a responsive partner, they expect her
not to engage in sex with others, even though they may give themselves
permission to do so. Often, without conscious awareness, they devalue the
sexually responsive girl that they enjoy and dedicate themselves to a relationship
of sexual frustration with a girl who uses her sexuality for secondary
gain.

The girl who, true to the double standard, has sex to please (and control)
the boy, rather than to please herself, offers a sense of security to an
unsure male. If she does not enjoy sex or pretends that she is disinterested
except to accommodate her partner, he need not worry that she will actively
seek or willingly respond to sex with others. He may seek sex for pleasure
outside his primary relationship and value, in a social sense, his non-sexual
mate. If her prudishness is a sham, she may also seek outside sexual gratification
and be seductive, responsive, assertive and/or experimental with another
partner.

These adult patterns have antecedents in childhood and are easily traced
through the ages and stages of development.

Birth to One

The first year of life is almost a purely physical experience for the
infant. The growth functions are under better control as the body chemistry
and the nervous system adjust to the post-natal environment. The increasing
maturation of the neurological system, the adaptation to physiological
independence, the ability to attend visually, the acquisition of basic
gross motor coordination and the differentiation of self from the rest
of the world through kinesthetic awareness, are all primarily physical
tasks. The formation of the symbiotic bond and the quality of the interaction
between child and caretaker is the foundation for the attitudinal structure
of the child. The attitudes about the body and body functions are the bases
for comfort or discomfort in sharing bodies in sexual intimacies and are
also the basis for self acceptance and self-esteem in a much broader context.
As early as four weeks of age, there is unmistakable psychological interest
in the bodily functions. Infants will display a sense of well-being after
completion of a meal, they enjoy their bath and contacts with mother's
body and they respond to the snugness of being wrapped or held. They have
a positive response to comforts and satisfactions and negative responses
to discomforts and denials. They are wakeful, attentive and comforted by
handling of the body, bathing, nudity, the caretaker's voice, closeness
to another person, movement and genital sensations. They fret or cry when
the alimentary tract or the eliminative organs are not functioning smoothly,
and they express demands and discomforts through crying and body language.

At about 4 months, the child will cry for social stimulation alone and
during breast feeding, will gaze intently at the mother's face. The neurological
system has matured to the point that his/her hands pass the mid line of
the body; and for the first time, s/he touches and is touched simultaneously.
During the second 6 months of the first year, the infant has a compelling
urge to use his/her hands for manipulation and exploration. The pincer
grasp develops, and her/his hand is no longer predominantly fisted. The
fingers are more nimble, and s/he fingers his/her fingers. The process
of self-discovery begins as one attempts to explore his/her world through
hands and mouth. The genito-urinary system is coming under better control,
and some girls are dry through their naps at this age. Near the end of
the first year, the emotions of affection, jealousy and sympathy can be
evoked.

Age 1

The 1-year-old child likes an audience, enjoys applause and may be the
very center of the household group. Responses from others to his/her thespian
antics help him/her develop a sure sense of self-identity, as does the
new skill of casting and releasing, which is the compliment of grasping
behavior, learned at an earlier stage. Dropping or casting is the neurological
forerunner of counting, bowel and bladder control and orgasm. The 1-year-old
is much more mobile and autonomous, and if not walking, is cruising and
can attain a sitting posture without help. Although there is a primitiveness
about their posture and coordination, the assumption of the upright posture
emancipates the hands for more sophisticated exploration and manipulations.
The hands are not yet agile at the wrists, thus the purposeful stimulation
of genitals is not often observed. Children at this age do show an increased
interest in the products of elimination. Girls laugh when urinating and
both genders love their bath and love taking off their shoes. They enjoy
a bath with older siblings, and they resist being dressed. They like to
undress themselves and run naked, especially out of doors, and if left
alone, divest themselves of all clothing except their T-shirt, which is
beyond their capability. They play alone on waking, and genital play is
common, as is feces smearing if the necessary ingredients are available.
Punishment and shame are commonly administered by parent to children of
this age in connection with bowel and bladder function, and the child may
begin to scold him/herself or cling to mother after an eliminatory accident.

Age 2

The growth continuum seems to take a giant leap at the second year.
Two is an age and stage which is especially meaningful in terms of adult
sexuality. Their neurological maturation has progressed through perpendicular
and horizontal phases, and now they come into the circular phase. They
have achieved the ability to rotate the forearm, which not only means they
can turn the doorknob, but can effectively and purposefully stimulate their
genitalia. The major focus of their life has to do with bowel and bladder
control; thus, much attention is directed to the pelvic area of the body.
As they are in the process of sphincter control, they utilize these systems,
along with genital manipulation, as tension release outlets. Most children
at this age can differentiate between bowel and bladder, have fewer accidents
and may demand to do it “themselves.” They are concerned about failures
and successes and may scold or give themselves credit for what they consider
bad or good behavior. They may be unable to move, may scream for help if
they accidentally wet their pants and may demand that father attend their
toileting when they need assistance.

The function of the genito-urinary system is not a simple local reaction.
It is a total response of a total organism which is a developmental or
maturational coordination of the involuntary mechanisms of the vegetative
nervous system and the higher brain centers. The elaborate neurological
network that allows for kinesthetic awareness and voluntary control of
bowel, bladder and sexual system functions is basically complete within
the first five years of life, although all systems remain highly susceptible
to psychological vicissitudes in childhood, adolescence and adulthood.

Conscious control over the retention and release of bowel and bladder
function is achieved by most children by age 6, if not before, and is considered
a major developmental task of early childhood. Much parental/caretaker
attention is directed toward the child's establishing a pattern of elimination
that is physically healthy, culturally proper and socially aesthetic. The
same attention has heretofore been denied the sexual function, which is
governed by the same need for kinesthetic awareness, conscious control
of retention/release and skill training. Adult sexuality has the added
dimension of a socio-sexual component; for in contrast to bowel and bladder
function, it is experienced and expressed in the context of a relationship
and needs to be a reciprocal, mutually satisfying and erotic, interpersonal
exchange.

Many 2-year-olds have problems going to sleep and may have nonproductive
sensations of needing to void. They may awaken during the night to go to
the bathroom (especially girls), and they love to be in the bathroom with
other family members. They still like to be naked; they love to romp, flee
and pursue, to fill up empty things, put in and pull out, tear apart and
fit together, to taste, touch and rub. They have a genuine interest in
mother/baby relationships, they love water and doll play; and both boys
and girls pretend they are the mother of their dolls. They may become shy
or affectionate with mother or caretaker; but in the later half of the
second year, they emerge into an exasperating transitional stage which
is equally balanced between alternatives. They are unable to think of one
choice to the exclusion of the other, and they're aptly called extremists.
They are conservative, ritualistic and paradoxical. They are learning opposites.
If isolation to their room is used as a punishment or control, they may
develop stable patterns of self stimulation in association with this new
sense of independence and autonomy.

Age 3

Three is coming of age. It is characterized by a high degree of self
control. Three likes to please and comfort and enjoys sedentary pastimes
that use fine motor coordination. Many 3-year-olds have gained inhibitory
control of sphincters and can almost toilet themselves during the day.
They have an interest in persons and watch facial expressions for the purpose
of finding out what they indicate. Three expresses affection, says, “I
love you” and can affirm his/her own sex (“I am a boy”), but often in the
negative (“I am not a girl”). They verbalize sex differences. Girls often
try to urinate standing up, and there is a desire to touch mother's breasts.
Threes have a great interest in marriage to the other parent and want the
family to have a baby. There is some basic questioning as to where a baby
comes from and an intense desire or need to relive their own infancy. They
may act out being a baby, want to have a bottle or nurse at the breast
and be carried in competition with a new sibling, even if the family does
not have a baby. Three-year olds can be a delight during the day, but wakefulness
at night is common; and often, a 3-year-old has a very active night life.
Dreams begin to be reported, and they may be very frightening even though
the child cannot recall or relate them. Three is also the age of imaginary
playmates on whom most of the bowel and bladder accidents are blamed. The
3-year-old will share stories of his/her imaginary playmate with mother,
but s/he needs and wants stories about him/herself from her. Three wants
to know everything about when s/he was a baby and wants the stories repeated
over and over. This apparently solidifies a sense of self. Three is beginning
to be able to make simple choices if the alternatives are clear. Worry,
thoughtful concern and memory indicate significant mental growth. Threes
will link events and reintroduce a topic of conversation with new insights.
Three-year-old J was fascinated by her mother's method of determining the
respective sexes of a litter of kittens. After the death and burial of
one of the kittens, she thoughtfully remarked, “I bet God had to look under
her tail, too.”

In the later half of the third year, the child begins to feel great
tension and expresses it through many compulsive patterns, such as stuttering,
eye blinking, nail biting, thumb sucking, nose picking, masturbation, spitting
and/or chewing on hair or clothing. It is an age of emotional extremes
in which three seems to be strengthening his/her will by practicing domination.
S/he may be extremely commanding and demanding with adults as well as peers
and may be intensely jealous of his/her parents? attentions to each other,
trying to separate them from affectionate embraces or demanding to be included.
Three-and-a-half shifts rapidly between extreme shyness and exhibitionism,
all in the quest of positive attention. His/her feelings are easily hurt
by failure or by people ignoring him/her or not doing what s/he wants them
to do. Threes' attempts at social interaction vacillate between demanding
insistence and obsequiousness. The intense need for attention, preoccupation
with bodily functions, interest and curiosity about reproduction and increased
ability to communicate verbally with adults can culminate in a pseudo-mature
seductive posture, especially in female threes who have been socialized
to be more tractable than many male 3-year-olds. It is quite common at
a party of adults to see the 3-year-old daughter of the host comfortably
curled up in the lap or laps of a succession of male guests capturing their
attention with her interpersonal magnetism.

She may even request that her “new friend” put her to bed and may hold
thoughts of him and make reference to him for days or weeks after the party.
This behavioral pattern is not exclusive to girls, but is somewhat more
pronounced, is better tolerated in terms of gender role stereotypes and
receives positive reinforcement from the involved adults. Similar behavior
in boys may be discouraged by negative responses or extinguished by lack
of response from most adults.

The potential for sexual stimulation in this situation is obvious, and
available data confirms the incidence of pedophilic genital fondling at
this age. The accessibility and vulnerability of the child may be beyond
the capable limits of an adult male with poor impulse control. The sexualization
of the adult-child relationship is not sin qua non a psychological trauma.
The sex histories of many adult men and women contain such experiences
that were not traumatic or that caused little concern until the sexual
activity escalated beyond looking and fondling or until the situation was
discovered and responded to negatively by other adults.

Age 4

Four-year-olds are out of balance, with both their muscles and their
mind. The 4-year-old is not quite as sensitive to praise as s/he was at
three; instead, s/he praises him/herself through bragging. Four is a great
talker. Questioning comes to a peak at this age, and his/her imagination
knows no bounds. S/he is a fabricator and alibier and will dramatize any
experience. Four is a master at anti-social conduct, likes to call people
names (often body parts or bathroom words), becomes defiant, emphatically
refuses anything that is not to his/her liking and may run away from home.
Actually, the 4-year-old is developing a strong sense of family and home,
with mother and sometimes father often quoted as the court of last resort.
“My mother said so,” is the definitive end of many arguments at this age.
Four-year-olds are truly social beings, and they are most relaxed and happy
when they are alone with one adult. There is some hint of tribal sociology
in the group life of 4-year-olds in nursery school, wherein groups form
spontaneously with specific rules and regulations. Both boys and girls
like to play house and may indulge in considerable household activity,
including dressing and undressing of their dolls. Four-year-olds are intensely
interested in death and may continue to have bad dreams, especially about
wolves. They are preoccupied with their belly button as something to consciously
cover or expose and may still believe that babies are born through the
navel. They ask where babies come from and may continue to believe that
they are purchased at the hospital, regardless of the explanation given.
In terms of genital play, they may play “show” with other children, boys
or girls; and although they may want bathroom privacy for themselves for
bowel movements, they are not so concerned about privacy for urination;
and they have a continuing interest in watching everyone else in bathroom
activities. They may grasp their genitals when under stress, and stable
masturbation patterns from age 3 may continue.

This is an excellent age to test the reproductive interest of the child
with accurate and more detailed explanations about procreation. Especially
if their environment includes pregnant women or newborns, their curiosity
will be stimulated; and they are quite capable of hearing the accurate
details. If they continue to report that babies get out through the navel
or that they are purchased at the hospital, it is not necessary to make
an issue out of correcting their misinformation. At a more appropriate
time, you may again tell the story of reproduction; and eventually, the
information will be assimilated and reported correctly. Many children are
quick to grasp the concept of intercourse and may make delightful, albeit
inconvenient, reference to their new knowledge. Four-year-old A in a conversation
with his mother said, “I'm a boy, and I have a penis; you're a girl, and
you have a vagina. We could put ours together. Do you want to, Mom?” Mother
answered appropriately that boys and mothers don't put theirs together,
just mommies and daddies: “When you're a Daddy, you will put it together
with your wife.”

Age 5

Five is a golden age. Development is a smooth organization and synthesis
of earlier experiences. Mother is the center of five's world: s/he likes
to be with her, please her, watch her, help her and be affectionate to
her. “I love you, Mommy” is expressed frequently in a burst of emotional
exuberance and quite often accompanied by hugs and kisses. Boys especially
may derive mischievous joy from romancing Mother with tight hugs and long
kisses in public or in front of father. Five's want to please, they want
to do what's right and they like the social interaction of asking and receiving
permission. “May I have a cookie?” and “I'm going to the bathroom now,
Mommy; is that all right?” are common verbalizations of the 5-year-old
and are a welcome change from the obstreperous four. Mothers are often
more comfortable with the closeness and dependency of the 5-year-old girl
and may be less so with a boy. Although cultural role stereotypes do not
endorse dependency as a male value, a boy's need at five to be close and
loving with his mother is essential as he, like his female counterpart,
moves from the make-believe, fantasy world of infant to the conscious reality
of childhood.

Fives are stark realists and want the details of life and living. Death
and after death, sex and reproduction are favorite topics for their emerging
intellectual philosophizing. They express a greater awareness of time and
can talk about past and future. They compare differences between the bodies
of girls and boys and show increased awareness of differences between the
sex organs of children and adults. With greater awareness of gender identity,
boys may reject girls' toys; but both boys and girls want a baby and may
dramatize the event by enacting what they know and have assimilated about
reproduction. They may attempt intercourse if the setting is conducive
and may put a doll under their clothing or between their legs to simulate
pregnancy and birth. They may verbally recall being in mother's stomach
or futurize a baby, in their own stomach. Boys may still occasionally say,
“When I grow up to be a Mommy,” but respond upon questioning that they
are destined to become fathers if they choose to parent. Fives talk of
marriage, but expect to marry a family member and live at home with their
baby. They may be upset and feel abandoned if the parent insists that they
will marry a stranger and leave home.

During this time, increased fine motor control is much improved; and
although the belly button may be omitted from human figure drawings, genitals
are often added, much to the consternation of the kindergarten teacher
collecting displays for public school open house! Sex talk is often embarrassing
to parents, even though it is honest and forthright on the part of the
child. Five-year-old B said, “Sometimes I see one fly sitting on top of
another fly.” Her mother replied, “Flies are like that.” She continued,
“I've thought and thought, and I've finally figured it out. That must be
her big brother giving her a piggy-back ride.”

Fives are basically in emotional equilibrium and evidence inhibitory
poise. They can assess social situations and often respond appropriately,
delaying their gratification to the proper time and place. They may continue
some tension reduction behaviors that are annoying to adults, such as a
thumb sucking or holding and rubbing of genitals; but pressure to discontinue
the tension relieving behaviors may produce more tension, resulting in
even younger patterns of behavior.

Fives have trust and confidence in themselves and others, but only to
a point. Negative experiences with a person or expectations beyond their
comfort level produce worries and fears that will be communicated to parents
or produce symptoms of anxiety. A 5-year-old will often report sexual overtures
or sexual behavior, especially from or with an adult, to mother in a matter-of-fact
way. Quite often, they have already turned down the invitation; and little
needs to be made of it. Five-year-old K reported to his mother that a 12-year-old
neighbor girl wanted to see his penis and offered to show him her genitals
in return. He had a social conscience and explained, “You know, Mom, she
doesn't have a brother to look at, but I told her if she wanted to see
a penis, to ask her dad because he has one.” Although there is little reason
to suspect peer sex play is a negative experience for 5-year-olds, parents
may be uncomfortable with it and hypothesize dire consequences at a later
date in order to give themselves permission to prohibit it. In point of
fact, every child is initially subject to the value system of his or her
parents and the arbitrary rules of the household. It is best to be clear
about what the rules are without burdening the young child with fear, doubt
and guilt.

Five is an age of fears of violence, the unknown and power (e.g., thunder,
darkness, abandonment, retaliation and punishment) that may cause nightmares
and inability to sleep alone through the night. It is wise not to inadvertently
include sexual concerns in this matrix of anxiety. Fives also have fantasies
of omnipotence (Superman) and a sense of humor (tricks, riddles, bathroom
jokes, etc.) that can be marshaled to combat their worries and fears. Stories
with victorious or humorous outcomes can replace their bad dreams, worries
and fears. Five-year-old C dreamed that a snarling wolf came into his bedroom
and wanted to bite off his penis. His therapist rewrote the dream so that
the wolf was snarling because he was hungry and he had a thorn in his paw.
When he saw C's penis sticking up (as it often did during the night), he
thought it was food. C woke up and helped the wolf get the thorn out of
his paw and fed him some dog food, and they became friends. He gave the
wolf a name, and the wolf agreed to watch over him while he slept so no
harm could befall him. This revised scenario caused C to gleefully announce
that the wolf probably thought that his penis was a weenie, and he revealed
that a nursery school companion used that term to designate his penis.

Age 6

Six is the center of his/her own universe. S/he wants to be first, wants
to win and wants to be popular and well liked. S/he is impulsive, indecisive,
volatile, compulsive and excitable. Six is plagued by bi-polar opposites
that vie equally in the decision making process. No matter what six decides,
s/he is sure the alternative should have been chosen. Six forgets his/her
manners, is active, restless and overextends to accident proneness. Six
is replacing milk teeth with permanent teeth, is physically less robust
and is susceptible to infectious diseases and somatized stress. S/he has
many fears (wild animals, ghosts and subhumans, strangers, physical injury,
deformities, dark, God, being buried in the ground and mother dying) and
at times, seems overwhelmed with his/her growing awareness of the complexities
of life. Six-year-old L reported that when his penis got hard, he hit it
to make it go down. When questioned, he admitted that it felt good when
it got big, but queried, “Have you ever heard of the story of Pinnochio?”

Six is egocentric, thinks s/he knows it all, believes his/her way is
right, projects his/her emotions and thoughts on others and cannot contemplate
the full person hood of others. His/her dual life at school and home is
hard to balance internally, and the academic and societal demands of school
may produce younger patterns of behavior at home or the wish to be a baby
again to escape responsibility. The sense of self as a member of the first
grade allows the child to defy and be critical of parents and siblings.
“So what?” is a favorite response in family interactions. Sixes love and
hate mother, but are most dependent on her for emotional sustenance. Six
is expansive or over controlled on a minute-by-minute basis. They are curious
about anatomy, but may be highly critical about the nudity and/or masturbation
of younger siblings. They like to talk to mother privately about many topics
including sex, marriage and death. Girls especially like to talk about
having babies, and both boys and girls want a baby in the family to take
care of and hold. They are curious about how the baby gets out and how
it gets in. They want details, but may be disturbed about thoughts of coitus
and/or delivery. Six-year-old W remarked that she would be “embarrassed
to have a baby with a doctor present.” After a lengthy discussion of the
history of childbirth, midwifery and infant and maternal mortality, etc.,
she philosophically proclaimed that she would have a physician in attendance
because “even though it would be embarrassing, it would be better than
dying.”

If sex talks with mother are open and comfortable, girls may ask to
see their mother's vulva. Some women are quite comfortable in complying
with this request, while others are not and may provide pictures of adult
genitalia and encourage the use of a mirror to inspect her own instead.
Boys and girls look at father in a new light as they imagine the details
of parental sexual interaction, and their questions may persist over a
long period of time and may be quiet personal. They have an increased ability
to conceptualize sexual information at this age; and even though it may
have been available at earlier ages, it has new impact and meaning at six.
Obviously, the quality and quantity of sex talk between parent and child
is dependent on the parent's comfort with and willingness to entertain
the subject. Children are quick to sense parental discomfort or unwillingness
to discuss sexual topics and many inhibit their interest and curiosity
and/or reserve the topic for peer discussion. The primary nature of the
body and the attention to physical concerns in the first five or six years
of life stimulate a spontaneous flow of questions and comments about sex,
anatomy and physiology from the child and offer a multitude of opportunities
for a parent to introduce appropriate levels of sexual conversation. Conversely,
it is easy to inhibit the sexual spontaneity of the child and pass up the
opportunity to carefully weave the threads of sexuality through the fabric
of childhood. In doing so, parents forfeit awareness of the child's sexual
development and nullify their influence in the tumultuous adolescent years
when sexuality is a primary developmental task.

Some sixes show a marked interest in anatomical differences; and playing
“show” and “doctor” help satisfy that curiosity, especially for children
who haven't had opposite gender siblings or playmates. Six-year-old K was
crying because her 14-year-old brother had locked her out of the bathroom.
Her mother explained that he wanted his privacy because his penis was beginning
to grow. K continued to cry and bang on the door as she replied “But he's
my brother, and I want to see his penis grow.” Penetration, either in masturbation
or mutual sex play, is most likely to occur at this age and may be vaginal
or anal (simulating the taking of body temperature anally, which is in
their experiential background). Sex play with older children is also common,
and a 6-year-old's interest and curiosity about sex may be easily exploited
by older siblings or extended family members and caretakers. Sixes are
much more apt to report to mother sexual contacts with older children or
adults than peer sex play, which most often goes unreported.

Significant changes in the sexual focus of the child occur somewhere
between the ages of 5 and 7. Freud suggested that this was the onset of
sexual latency and that the healthy child ceased all sexual interest and
behavior and was vulnerable to sexual trauma if his/her environment was
not devoid of sexuality. Sexologists find little or no evidence to support
the latency theory, despite its durability as a concept in analytical psychiatry
and its continuing influence among the clinical mental health community.
Observation of children does reveal a higher order of development and an
organization of behavior that might lead to the hypothesis of sexual latency;
however, sexual interest and behavior is a durable, and ever-present phenomenon
throughout the tenure of childhood. The significant change has to do with
the child shifting from bodily concerns to mental concerns.

Age 7

Seven is an age of assimilation. Self-absorbed in a world of his/her
own, 7-year-olds order and assimilate knowledge, experience and philosophical
and psychological constructs through reflective fantasy. Seven learns the
meaning of things and people and develops “feelings” about them. The importance
of his/her mental activity produces moodiness, shyness and extremism. Seven
feels no one loves him/her, everyone hates him/her, s/he can never do anything
right, things are never going to work out, s/he always loses and everyone
has it better. Seven broods over things in terms of the impact they will
have on him/her. S/he sees people and things in perspective and achieves
a new sense of self through detachment from mother. Relationships with
others are important, relinquishing dependency on mother; and sevens often
fall in love with their second grade teacher. Speech becomes increasingly
important as the personality development fosters self-reliance. With verbal
negotiations and reminders, sevens can become handy helpers. They are assertive,
have definite ideas and mutter, argue and sulk if they are treated like
a child. Sevens are not good losers and easily drop into self-pity and
self-righteousness. Seven is ashamed to cry, doesn't want peers to laugh,
hates to be teased and fears humiliation. S/he blames others, create alibis
for their shortcomings and may engage in behavior that is labeled lying
and stealing by adults. The emerging ethical sense is in the process of
sorting out the import of actions on self and others; and what appears
to be dishonesty is more accurately described as advantaging self with
the result, if not the intent, of disadvantaging others. Seven is reflective
and self-critical and is often called the “eraser” age. They persevere
and repeat always with the anticipation of an improved result. They have
growing awareness of time and space orientation and can tell time, but
cannot keep track of it. They are less fanciful than they were at six,
and they have an interest in cause and effect and how things actually work.
Sevens can bathe and dress themselves, but may need help in getting started
and reminders to stick to the task until it is completed, as they have
a tendency to get distracted. They often love their bed and do not resist
going to bed, but may lay awake for an hour or more and develop nighttime
rituals to combat fears and tension.

Few report regular masturbatory rituals at this age, and masturbation
tends to be spontaneous rather than premeditated. Sevens may begin wearing
their underwear under their night clothes for a sense of security. Few
sevens still wet the bed; and if they arise to toilet during the night,
they do not need help. Sevens have many tensional outlets that are seen
as bad habits to parents. Thumb sucking may persist, but usually it gives
way to nail biting, nose picking, fidgeting, loose tooth wiggling and holding
or rubbing the genitals. Their insecurity and withdrawal tendencies include
sensitivity about exposing their bodies. They are embarrassed if younger
siblings are blatant about nudity and/or sex, and they are especially sensitive
about the opposite sex sibling or playmate seeing them without clothing.
If stimulated to think of sexual things, sevens may draw sex pictures.

They are curious about pregnancy, especially if there is a baby expected
in the family. They know that having babies can be repeated, and they express
a desire for a same-sex sibling. They want answers to their sexual questions
recounted, and many enjoy private sex talks with mother. They love to feel
the baby kick, they have more interest in how the baby gets out than in
and they have practical questions about delivery, such as cost, mother's
hospitalization, post natal events, etc. Seven may have a romance, write
notes, give gifts and fantasize marriage; but the loss of the boyfriend/girlfriend
is accepted as a matter of course. They have interest in sex role differentiation
and less concern with anatomical differences. A 7-year-old boy with interests
and behavior considered female may illicit derision and teasing from peers.
Usually called “sissy” or “girl,” the term “homo” may be introduced at
this age and used as a synonym for effeminate. Girls do not suffer the
same derogation, even if they are labeled “tomboy.” Sevens have grown out
of their baby look and their baby ways. They are not cute and cuddly and
do not elicit the same responses from adults.

Age 8

Eight emerges from 7-year-old inwardness to expansiveness. Reminiscent
of the out-of-bounds 4-year-old, eight is truly four plus four. Eights
are speedy, adventuresome and confident in their ability to accomplish
new feats and challenges, both physically and mentally. They are curious,
energetic and robust. They are in perpetual high gear. It is an age of
excess; and although their boisterous bravado is an age norm, it often
is more pronounced in boys than in girls. This onset of prepubescence finds
the sexes drawing apart in terms of gender role behaviors and segregating
into same-sex groups for work and play.

The sense of self is demonstrated in gender identity and status concerns.
Eights need and often ask for praise. They are extremely sensitive to criticism
and are easily humiliated if their shortcomings are publicly pointed out.
They retain a close attachment to mother as they are detaching from dependencies
in other relationships. Mother is their confidant for worries, fears and
confessions of misdeeds. “Mom, I have to tell you something, but promise
you won't tell Dad” is a common preface to revelations of worrisome situations.
It is important to keep these confidences to ensure an ongoing trust bond.
If the incident is something that father should eventually know, the child
can be encouraged to confide in father and, helped by an understanding
mother, to select the best time and method if father is difficult to approach.
Trust between parent and child can easily be lost forever by not respecting
the privacy needs of the vulnerable 8-year-old, sacrificing the coveted
role of sexual consultant in the upcoming teen years. When asked if they
would be the first or last to know if their child were in serious trouble
(pregnancy, V.D., drugs, etc.), most parents of teens usually answer “first.”
When children of these parents are asked the same question, they invariably
answer “last.” Scores of adolescents seek sex counseling, abortions, medical
care for V.D., etc., without parental knowledge, not to mention teens who
run away from home or commit suicide due to problems they feel they cannot
entrust to the family for help and support.

Eight is less dependent on teacher as the peer group becomes increasingly
self regulating. Interest groups are spontaneously formed, with rules and
regulations adapted as they are needed. Eights can give and accept just
criticism from peers, have a germinal sense of justice, can negotiate,
abide by rules and can admit wrong-doing if allowed to justify, qualify
and explain what they believe are mitigating circumstances. Eights like
to challenge themselves and to master skills. They are dramatic and expand
into new worlds through fantasy, exaggeration and wishful thinking. They
collect, organize, serialize and horde. They love money: they like to save,
spend, barter and bargain. They have a curiosity about life in other countries,
the origin of life, procreation, marriage and babies. They want to know
more about the insides of the human body and the insides of the earth and
the geography of heaven. Their sex interest is academic rather than erotic;
however, the greatly enhanced peer group activity is conducive to group
masturbation and homosexual or heterosexual experimentation. Younger children
and/or girls are often allowed into the secret boys' club for sex play
and denied admittance at other times. Passwords, initiation rites and membership
dues are often focused around sexual and/or monetary issues; and privacy
is insured by an appointed look-out in the club treehouse or fort.

Eights are glad to be alive. They do not dwell on negative thoughts,
they arc more comfortable with adults and they are beginning to doubt the
infallibility of parents. They like to tease and test adults with jokes,
riddles and exaggerations.

Physically, eights are graceful, coordinated and sure of their bodies.
Despite prepubescent lengthening of arms and increased hand size, fine
motor performance is smooth and reliable. Eights like to draw the human
body in action and may include sexual and eliminatory activities in their
graphic repertoire. Their tensional outlets are minimal at eight, but may
include a need to urinate or a pulling at their pants, either at front
or back. Other outlets such as thumb sucking, nail biting, etc., drop out
or are systematically phased out by the child determined to master his
or her own impulsive behaviors. Eights are competitive with others, as
well as being in continuous competition with themselves. They set up obstacle
courses for themselves, rewarding and withholding rewards for their own
personal demands. Eight is increasingly aware of him/herself as a person.
They are more conscious of how they differ from others and want to be recognized
as individuals. They respond well to special privileges, “because they
are eight”; and in keeping with their increased interest in sex (specifically,
father's part in reproduction), appropriately inscribed sex books are a
perfect gift for the 8-year-old.

There is much confusion over sexual facts at this age, and many children
are not knowledgeable enough or comfortable enough to ask parents the appropriate
questions. Parents may be willing to answer if asked and assume that if
the question is not forthcoming, it is too early to offer information.
Both boys and girls are curious about the total process of reproduction,
and few can accurately piece together the information received thus far.
They are also beginning to be interested in boy/girl relationships and
may be involved in sex play (often with older children who may have established
coital expectations). Eights expansive curiosity and daring, their admiration
for older children and their susceptibility to a reward system combine
to produce an easily
exploitable sexual situation. Eight-year-old C wanted desperately for
her mother to have a baby. Her mother said she and her new husband were
trying to have a baby, but with little success. When C found out that her
mother was taking birth control pills to prevent conception, she angrily
refused to communicate with her mother or her stepfather and vowed to have
her own children when she grew up. One day she queried her therapist, “If
you want to have babies when you grow up, do you have to practice when
you're young?” After assurance that most women do not have difficulty getting
pregnant and that prepubescent practice was unnecessary, C revealed that
her friend P, aged 12, was suggesting that if she didn't practice now,
she might not be able to have a child when she grew up. He was also kind
enough to volunteer his services in this regard.

Although eight is the age of separation into same-sex play and interest
groups and a critical appraisal of the difference between boys and girls,
a child's “best friend” may still be of the opposite gender. Sex information
is often exchanged in this dyad, with each child sharing information from
other sources as well as his/her own conclusions and concerns. Boys with
a female confidant are fortunate because they are more likely to learn
about menstruation, and girls are more apt to be interested in the sexual
function of the man's body (beyond just planting the seed). After reading
an age appropriate sex book, 8-year-old S remarked to her mother, “I have
to read the chapter on the man a few more times before I get all that vas
deferens stuff straight.” Eights maintain a high interest; and the importance
of accurate sex information cannot be over-emphasized, as the amount of
information to be assimilated is well beyond that which is mastered in
a typical “birds and bees” lecture. Books of their own, lovingly inscribed
by their parents, endorse a child's interest and curiosity about sex and
provide a reference that can be returned to and shared with friends. Graphic
depiction, photos or sketches, are also important learning aids as our
culture becomes increasingly visual. Books and pictures about the body
and sex help children understand that human sexuality is a legitimate academic
subject that can be explored objectively as well as subjectively. They
learn to satisfy a good deal of their sexual curiosity vicariously and
become less dependent on trial and error learning. Most eights read well,
love comics and picture magazines (especially catalogs) and enjoy being
read to. Children who have difficulty reading or dislike reading may stick
with a sex book because they are vitally interested in the subject matter.
Age appropriate sex books are needed by both boys and girls, but may be
considered more crucial for boys, as boys tend to get more sex information
from friends and printed material and less from conversation with parents
than girls do. Eights want to be good and they seek permission, praise
and parental endorsement. They like to collect things and to admire their
possessions. A growing library of sexual reference materials, endorsed
by parents, bequeaths automatic status among peers, ensures continual sexual
dialogue between parent and child and minimizes the possibility of sexual
exploitation by more knowledgeable children or adults.

Age 9

Nine is an intermediate age--no longer a child, but not yet a youth.
Characterized by self motivation, nine can put his/her mind to things on
his/her own initiative. Nines are less dependent on environmental support,
like to plan in advance and have to “think about things” first before doing
them. Nines can sustain repetitive tasks and are interested in perfecting
skills. They are capable of objective self appraisal and are critical of
others as well. Nine is often called absent-minded, but s/he is actually
mentally preoccupied. They like to identify, classify, seriate and categorize.
Nines have insight and can give accurate descriptions of the character
traits of individuals and the dynamics of specific relationships. These
estimates of people and their interactions can be penetrating and candid.
Nines have a keen emotional and intellectual interest in justice, punishment,
privilege, rules and procedures. They are basically honest, can accept
blame and are preoccupied with “fairness.” They have a loyalty and pride
in home and family, but do not want to be babied by their parents. They
often prefer peer activities to family doings, and they ask to bring a
friend on family outings. They love to talk and build friendships of depth
and duration. Clubs are still popular, with passwords, dress codes, rituals,
secret meeting places and taboos helping to establish a sense of camaraderie
and brotherhood.

School and interest groups include both boys and girls, but spontaneous
groups and birthday parties are usually unilateral. Boys roughhouse and
wrestle; girls giggle and whisper. They tease each other about opposite
sex friendships, and each group cordially disdains each other. The love-hate
vacillation between sexes at this age abounds with prepubescent energy.
The 9-year-old's sense of independent self is accomplished in terms of
age (detachment from parents) and gender (differentiation of the sexes).
This reinforced gender role identity, expressed at nine most often in the
negative preoccupation with the traits and characteristics of the opposite
sex, allows for subsequent heterosexual attraction. Girls are nearer pubescence
than boys at nine, but both are increasingly aware of their impending transformation.
They are interested in sex information in an intellectual, realistic sense,
but may not connect it to their own social interactions. Boys and girls
are interested in babies, have affection for and patience with younger
siblings and can be depended on for short stints of baby-sitting or childcare.
They are more interested in their own origins and functions than those
of the opposite sex. They may show little interest in reproduction if questions
have been answered earlier. They may have a girlfriend or boyfriend, but
usually in name only. They may share this friend with a friend, expressing
no jealousy. This rather impersonal relationship may in fact have been
arranged by a friend; and although notes are passed, Valentines exchanged
and the boys may seek a kiss as a conquest, these relationships tend to
be off-again/on-again with little personal involvement. Kissing games are
common at mixed parties, but most parties at this age are gender specific.
Nines are shy in formal boy-girl situations, and they may be shy about
undressing, even in front of younger siblings of the opposite sex if a
same sex peer is visiting. There is a heightened differentiation of boys
and girls of this age, and they remind each other of appropriate gender
role behavior. Sex talk is reflected in swearing by both boys and girls;
bathroom talk is still used, but sex words and jokes are increasing. They
may shock mother with crude jokes, riddles and rhymes and need much help
in defining words and concepts, as well as differentiating funny, acceptable
sex jokes from gross, offensive ones.

The ethical sense is rapidly developing at this age, and nines feel
guilt and shame when they fall short of their own expectations and/or the
expectations of others. Their critical and judgmental abilities are often
sharp, and their need to know themselves through recognizing their differences
from others sets the stage for the possible development of prejudice. Although
their intellectual realism and overriding sense of fairness can be appealed
to, the roots of sexual prejudice are often left unchecked at this age.
The terms “fag” and “homo” are used as pejoratives even though they may
be poorly understood. Boys control their friends and taunt their enemies
with these words and in doing so, contribute to their own homophobia. Few
adults address this issue as they might tackle a similar situation involving
religious or racial prejudice. Although some adult homosexuals recall incidents
in childhood which they identify as precursor to their later sexual lifestyle,
9-year-olds are not conscious of their future sexual preference. If they
learn to view homosexuality as a despicable state, they will suffer severe
cognitive dissonance when they later find themselves attracted to same-sex
partners or when they discover a valued friend to be gay. The terms “fag”
and “homo,” like “MR” and “spastic” and various racial or ethnic derogations,
are most often used as generic insults without empathy for the sensitivity
of any person for whom the reference is applicable. A significant component
of homophobia is ignorance; and when the terms are used, they should be
defined and explained by a knowledgeable adult. Boys tend to use “fag”
and “homo” to describe immature and/or effeminate behaviors of their peers;
thus, a discussion of the differences between androgyny, homosexuals, transsexuals
and transvestites is appropriate. If terms are used in response to affection
or physical closeness expressed between boys, a discussion of our cultural
stereotype of masculinity as the denial of feelings and emotional needs
can be initiated.

Age 10

Ten is an age of glorious equilibrium, with many qualities of adulthood.
The gender differences are pronounced, with girls manifesting social behavior
which is considered more mature. Ten is impressionable and adaptable. One
can appeal to the reason of a 10-year-old because his/her mental process
can objectively consider the fundamentals of human welfare. Fifth graders
are interested in social problems. It is a phase in which ideas can be
broadened and it is an age of prejudices. Adverse conditions can lead to
delinquency and gang violence, including sexual violence.

At this age, tendencies and abilities emerge that are predictable of
adult traits and careers. Leadership is assumed by some children, and individual
differences are accepted. Tens have opinions about everyone and everything,
and their descriptive appraisals include the positive and the negative
aspects, pronounced matter of factly. Tens enjoy family and groups, are
capable of hero worship and love to share secrets. Boys' activities tend
to focus around gross motor games and sports, and their spontaneous play
is action oriented, with one challenging the other to informal bouts of
wrestling, racing, climbing, etc. At 10, many boys are involved in organized
team sports that focus the family on their performance.

Girls' physical touching is affectionate rather than aggressive. They
hold hands or walk with their arms around each other, and they are more
interested in relationships. They gossip, write notes, keep diaries and
play dolls to act out their interest in romance, weddings, marriage and
children. Girls are more interested in and aware of interpersonal relationships
and will begin and end relationships based on their evaluation of the personal
qualities of the other person. There is less team play or team spirit (i.e.,
accepting faults and inadequacies along with talents and strengths) in
girls than in boys. Girls operate in smaller, more personal groups, and
they are more aware of themselves, their appearance and their expectations
of others. Girls have more interest in love and romance, and peer boys
are a consistent disappointment in this regard. Girls at this age are often
in love with a considerably older boy or adult male. Girls and boys are
about equal in size; however, many girls will experience nipple enlargement
and the beginnings of pubic hair in their 10th year. Girls have an increasingly
practical interest in menstruation, some looking forward to it as a symbol
of maturity and others resisting and denying that it will happen to them.
Girls are less likely to tell sexual jokes, but are interested in the parental
sexual relationship and may ask personal questions about it. If parents
are divorced and dating, daughters may probe for the intimate details of
their new relationships. The balance between open communication and confidentiality
of intimate relationships may be aided by the use of age appropriate sexual
reference books. Some 10's are embarrassed to receive sex information and
even deny reading sex books. Many are embarrassed to be seen without clothes
on, especially by opposite sex siblings or opposite sex parents. This shyness
is especially true when secondary sex characteristics begin to appear,
and it is exacerbated if they are teased about their body changes.

Boys are less likely to question parents about sexual matters and more
apt to repeat sexual and elimination jokes and rhymes and to use sexual
words as pejoratives. Most are aware of the male's role in reproduction,
understand the fundamentals of intercourse and have had some sexual experience.
Few have noticeable physical changes, but may require bathroom and dressing
privacy from mother and sisters. These same boys may peek at sister and
friends whenever possible. Boys begin to differentiate sex jokes that can
be appropriately shared with mother or girls, and a few 10-year-old boys
develop a strong attraction for a specific girl. Boys and girls consider
their mother a friend, confide in her, request private time with her and
think up nice things to do for her (e.g., surprises, breakfast in bed,
etc.). Fathers are often idolized, and companionship with father is sought
by both boys and girls. Tens respect their parents and want them to be
fair--not too strict, but not too easy.

Ten is good with siblings under five, but has real problems with siblings
from six to 10 and is often considered a nuisance and a pest by older siblings.
Friends are paramount at this age and ever-present if allowed. Sleeping
over is a favorite activity, and sex talk and experimentation is common.
Few children are encouraged or allowed to entertain opposite sex friends
overnight, so there is a tacit parental endorsement of same-sex acts. Most
children feel that same-sex experimentation is normal and age appropriate,
but that heterosexual coupling should be reserved for adulthood and reproduction.
That is not to say the heterosexual play does not occur at 10, because
it does for some. However, it is wise to consider that the age specific
division of the sexes, the earlier focus on reproductive information and
the parental unconcern over the sexual potential of same-sex friends all
combine to produce in the mind of a 10-year-old, a tacit adult approval
of homosexual experimentation, all the while producing quite a different
mind set about heterosexual experimentation.

Age 11

Eleven is the age of beginning adolescence and a time of perpetual motion;
the inner hormonal activity produces a new awareness of the physical self.
New feelings and sensations are physically expressed in accelerated growth
and gender specific anatomical differentiation, as well as in gross and
fine motor movements, facial expressions, emotional swings, verbal excesses
and boundless curiosities. Sixth graders can be the life of the party,
but are often described as pests. They are critical of parents and other
adults and argue for the sake of argument. It is the age of the worst rejection
of mother, but they are also rebellious with teachers. They may hate school
and attend only to have contact with friends.

They are resistant to logic and reason, have discovered the relativity
of right and wrong and have no guilt over wrongful acts perpetrated in
self-righteous anger or to get revenge. They swear, cheat, steal and lie
to get out of jams. Some report occasional smoking and drinking. The group
continues to be important, and interpersonal relationships are paramount.
Friends continue to sleep over, but there is a great deal of breaking up
and making up. Jealousy, quarreling and fault-finding is at an all-time
high, with boys somewhat less intense than girls in interpersonal matters.
Boys maintain more of a group spirit and are often naughty and disruptive
in the classroom and on the playground.

Many girls are still in an anti-boy stage and have a consuming interest
in horses. As girls begin to develop secondary sex characteristics, they
gain status among other girls and popularity with the boys. The more mature
boys court and tease the developing girls, wanting to know bra sizes, trying
to see up skirts, etc. Recreation centers are the meeting place, for the
physical female form is well serviced in the athletic arena. Not only is
sports attire revealing; but, if well directed, the periodic water balloon
fights produce a spontaneous wet Tshirt contest. Female athletes do well
socially in the sixth grade because of proximity to sports minded 11-year-old
boys. Athletic prowess is still the major rite of passage for American
boys, and they are preparing for junior high and senior high school competition.

Elevens are gaining increasing understanding about sex and elimination
functions. Understanding sexual complexities at 11 is facilitated by discussing
sex as a body function. Moral and social considerations are better left
for later. Eleven has been described as a “nothing age” because sixth graders
await promotion to junior high with anxious anticipation laced with varying
degrees of trepidation. This transition is somewhat dependent on public
school patterns (i.e., K-6, K-8,. etc.); however, for most youngsters,
junior high represents P.E. and showering at school, often in group showers.
For some, this may be their first experience of public nudity, coming at
a time of intense concern over the acceptability of their changing body.

Age 12

Twelve is the age of enthusiasm, initiative and diplomacy. The peer
group gains in importance; however, relationships with adults are characterized
by reasonableness, objectivity, empathy and insight. Twelves are emotionally
less volatile than elevens or thirteens; they are self disciplined, have
greater self-control and accept and fear control and direction from teachers
and others. Twelve is an intellectual age in which mental tasks intrigue
and inspire. Twelves like to debate political and civic issues and plan
group projects. They have sustained capacity for fact learning and an increase
in conceptual thinking. They are more literate, more articulate, more realistic
and more tolerant. They often write letters to public figures, start businesses,
enter contests, publish newspapers, etc., extending themselves well beyond
the world of childhood. Their health and stamina is basically sound and
reliable. Girls experience their most rapid growth in both height and weight,
achieving 95% of their mature height. Breasts fill out and nipples darken,
axillary hair sprouts, menarche occurs near the end of the 12th year and
freckles appear. Body odors change and intensify, and hygiene needs increase.
Some girls may express self-consciousness about breast development by attempts
to minimize their changing form, while others augment nature and flaunt
their new proportions. Girls need acknowledgment and endorsement of their
emerging sexuality from family members if they are to integrate their sexual
self into their total self-concept. It is important that parents neither
over-value nor under-value (ignore) the physical changes of pubescence,
but rather that they celebrate reproductive potential as the passage from
childhood to adulthood that it truly signifies. It is an artifact of complex
civilization, not biology, that girls will probably delay childbearing
for close to another decade even though the physical and psychological
readiness to reproduce is a phenomenon of adolescence.

Many girls look forward to menarche, but even so, may be ambivalent
when it occurs. Twelve-year-old A, eagerly anticipating menarche, began
her first period on a Friday and that evening, asked to spend the night
with her grandma. Her mother asked if she had included sanitary napkins
in the overnight bag. She had not and asked if it was necessary. Mother
explained that Grandma would not have any at her house and that she should
take at least two. As A went off to get them, she muttered, “this having
your period isn't as wonderful as I thought it was going to be.”

As girls adjust to the rituals of menstruation and their periods become
more uniform in nature and regular in occurrence, they become more positive
about growing up and more knowing about sexual matters in general. Because
the early periods are not usually accompanied by premenstrual signals,
most girls experience the embarrassment of spotting, and/or they may be
excused from P.E. or showering, which serves notice to peers that they
have reached the milestone of menstruation. Girls who mature more slowly
may be pleased that they do not have to experience the inconvenience of
menstruation and/or concerned that they are not one of the group. Girls
talk in the abstract about sexual matters and may need to clarify previously
held misconceptions with peers, parents and/or other adults. Sometimes,
a specific teacher develops a reputation as a reliable source of sex information
and is queried regularly to clarify the myths and misconceptions that reliably
surface during these junior high years. It is remarkable that despite their
inaccuracies, sex jokes and stories are perennial, resurfacing at the same
age generation after generation.

Boys are more interested in hearing and repeating sexual jokes and in
acquiring sexually graphic materials. Twelves have a good sense of humor
and wit and love the double entendre. They can be embarrassed by sexual
situations or jokes, especially if the joke is on them, i.e., sexual naiveté
or ignorance in the midst of others' knowing. Understanding the sexual
components or meanings of heretofore nonsexual words and actual sexual
vocabulary is a major task of the pubescent child. It is a rite of passage
that separates childhood and adolescence. Boys are usually more conversant
with sex words and meanings than girls, but they too must learn. Social
custom dictates that if you understand the sexual implication, you acknowledge
that understanding. If you do not understand, you ignore the implied sexual
connotation. You never attempt to learn by asking the meaning or definition
because this is the age of jokes and secrets. The harder you try to find
out what was funny, the more secret the information becomes and you become
the joke.

There is a wide range of physical growth differential among 12-year-old
boys, but the majority show some evidence of beginning puberty. Growth
of the penis and scrotum is common and may precede or succeed pubic hair.
Pubertal fat is most common at 12, but gradually emerges into accelerated
growth and a myriad of secondary sex characteristics, e.g., broader shoulders,
longer arms and increased muscle density and definition. Twelve-year-old
boys are becoming more interested in sex, especially their own sexuality.
They are more fully aware that sex occurs for reasons other than reproduction,
and heterosexual boys begin to acquire pictures of nude females. They tend
to think of sex as dirty, want accurate information and would prefer to
seek information from a neutral adult. If they do consult with a parent
in sexual matters, it will more often be the mother for specific information
rather than a full discussion of sex in general. In the absence of a sexual
confidant, boys will seek out information from printed sources and have
bull sessions with peers to discuss sexual matters to the extent of their
pooled knowledge.

Masturbation increases in frequency, may be experienced alone or in
groups and may or may not produce ejaculation. Erections occur with or
without external cause and may happen spontaneously at inappropriate moments,
causing embarrassment and anxiety about future situations. Externally triggered
erections may also be embarrassing, as they are caused by various stimuli
often deemed inappropriate by the boy (e.g., sex talk, shuffling or physical
contact with male peers, fear, rage, embarrassment, etc.). Twelve-year-old
heterosexual boys are interested in girls; and although most prefer group
activities, some fall in love and openly express their affectionate feelings.
Kissing is a favorite activity; however, having a girlfriend or boyfriend
is more a social phenomenon than an interpersonal one. The assignment of
couple status has little or no interpersonal responsibility. It is changed
frequently without emotion and is often decided by a group or a “marriage
broker” within the group. A few boys at this age, or seventh grade boys
who may be in or closer to their 13th year, may actively seek sex with
girls. They do not ask permission, thus exempting the girl from verbalizing
responsibility, but begin simply to see how far they can go. It is common
for junior high girls to stay overnight with a friend and arrange to meet
boys who are doing the same. Boys are always aware of girls' slumber parties
and make themselves available. When sex occurs between a boy and a girl
of this age, the boy tells his friends who, in turn, question him for details.
He acquires status among peers as they learn about sex acts, socio-sexual
negotiations and their female peers. Girls do not confide in their friends,
neither are they questioned by their friends about sexual encounters.

Thirteen-year-old B performed cunnilingus on 12-year-old F. He was the
first in his circle to have the experience, and so he became the “man of
the hour” among his curious friends. The information was passed to the
girls, who were shocked and unbelieving, but none asked F for confirmation,
denial or details. This pattern is stable through high school, with boys
talking and sharing sexual experiences for knowledge and endorsement and
girls gossiping about the sexuality of others but rarely, if ever, sharing
first-hand sexual experiences and concerns. One female high school senior
remarked, “you don't tell anyone anything about sex that you don't want
repeated, not even to your best friend,” the result being a large number
of sexually naive and uninformed girls, who have misconceptions and misinformation
about sexual matters. They depend primarily on experiential learning for
sexual knowledge and rely on boys to teach them how to be sexual.

In the seventh grade, the group is becoming increasingly important as
an arbitrator of fad, fashion and mores. Groups and sub-groups dictate
clothing styles, behavior and language. There is competition between groups
and within groups, the main purpose of which seems to be the integration
of a post-pubertal sexual self and the rudiments of mate choice.

Homosexual 12-year-olds may or may not be involved in sexual activity
with peers even though there is more opportunity for them than there is
for many heterosexual youths. Some heterosexual twelves are still engaging
in sexual activity and exploration with same-sex peers. Many adult homosexuals
retrospectively report gradual awareness of not being turned on to opposite
sex peers at this age, but few twelves declare themselves homosexual or
bisexual.

Age 13

Thirteen-year-olds are usually in the eighth grade, and adolescence
is well underway. They withdraw from the family circle and at home, may
be critical of parents and siblings. They are worried about aspects of
self, especially that others won't like them. Self-absorption and rumination
allow for internalizing awareness, which is the hallmark of this age. This
solitude is not escape from reality, rather it is time of self-examination
and rehearsal of future events. Reflection releases the 13-year-old from
the tyranny of instinct and creates a sense of increasing “will power.”
Thirteen's growing intelligence is manifest in his/her pleasure in rational
thought. Thirteens are interested in psychology, probability and hypotheses.
They are sensitive to criticism and keenly perceptive of the emotions of
others. They are given to self appraisal and may be quite objective. Thirteen
and a half-year-old M announced to her mother that she felt that she was
passing into a new stage, asking, “don't you notice that I haven't been
so obnoxious lately?”

The 13-year-old can be quite a trial in the family constellation. Thirteens
need privacy, often secede from the family and have difficulty with siblings
aged 6 to 11. Thirteens are moody and uncommunicative, critical of parents,
siblings and friends. They have fewer friends and are less apt to be interested
in girl/boyfriends at this age. They make firm declarations about neutrality
and few “date” at 13. Boys are catching up with girls in size, but girls
complain about their awkwardness and clumsiness. Boys and girls are preoccupied
with personal appearance and their effect on others, with much time spent
studying their reflected image. The mirror is their best friend, worst
enemy and constant companion. It provides self-discovery, self-assurance
and doubt and plays a constructive role in defining the realistic sense
of self. Thirteens compare themselves to movie stars, TV personalities
and characters of literature. School, playground and neighborhood offer
additional opportunity for comparison and definition as 13 identifies similarities
and differences between him/herself and others. School is often the optimal
environment for 13s. Their interest is broad, encompassing science and
liberal arts. They are curious, interested and willing to tackle subjects
in depth. They are hungry for facts and love to be the expert. They are
capable of inductive and deductive reasoning and like to consider complex
problems that have no easy answer. In the proper setting, they like to
entertain sexual concerns, such as, “if population control is desirable,
why is the Pope against the Pill?” They are curious about birth defects,
twins, multiple births and ask the age-old questions about cross species
fertilization. They are interested in birth control, venereal disease and
the fertility cycle of women. Boys and some girls still have many misconceptions
about menstruation and fertility that can be easily cleared up at this
age. Most report that they are too young to have intercourse, but they
expect to do so when they are older.

The 13th year is pivotal as the body becomes primary once again. The
adult body image forms as the individual genetic structure and environmental
factors determine body build, chemistry, posture, coordination, appearance,
voice quality, facial expressions, inner attitudes and tensions and overall
state of health. The mind expands dramatically in range of interest and
ability to reason, reflect, concentrate, accumulate and assimilate facts
and exercise independent thought. Personality emerges as a complex interplay
of mind and body as each individual assimilates these somatic events and
mental machinations.

Most girls at 13 are child/woman in appearance and behavior. They may
arrive at school in pigtails and jeans one day and in a dress, nylons,
make-up, coiffured hair and magenta fingernails with decals the next. They
vamp their favorite male teacher and keep diaries full of romantic hopes
and dreams. Most have achieved 95% of their adult height and are menstruating.
They are continually concerned about changing body contours, but their
central sexual focus is menstruation. Most anticipate it and are relieved
when it occurs; however, they may resent the necessary rituals once it
arrives. Their periods are usually not painful, neither do they usually
conform to the usual 28 day cycle. Girls are ambivalent about others knowing
that they are menstruating and most do not want to buy their own sanitary
napkins, feeling that it is too embarrassing. Thirteen-year-old M started
her first period on a Saturday and asked her mother not to tell her father
and brother. When mother replied that she already had, M asked with great
anticipation, “what did they say?” Mother replied, “they are both happy
for you.” She was delighted and asked if the family could have Sunday dinner
in the dinning room with the good china and crystal. When her mother agreed
that a celebration was appropriate, she asked if she could invite the extended
family. Her mother advised that it was pretty short notice, but perhaps
one aunt and uncle might be able to come. M remarked, “maybe we shouldn't
call them because it would be pretty embarrassing to tell them why they
are invited, but we celebrate every other important occasion in our family.”
As a culture, we fail to celebrate fertility and see it rather as a disadvantage
if not an outright danger of adolescence. This contradictory message regarding
the relative merits of maturity is not lost on teens.

The 13th year brings more definite maturational changes in boys also.
Most begin their growth spurt in height, closing the gap in the differential
with girls. There is rapid growth of genitalia in more than half of the
boys, and pubic and axillary hair grows in about two thirds. Facial changes
are marked with darkened hair at the corners of the upper lip, disproportionate
nose growth, increased angularity of face, enlargement of the Adam's apple
and cracking or deepening of the voice. Erections occur with direct physical
stimulation, erotic fantasy and in response to sex talk, the viewing or
reading of sexually explicit materials and spontaneously or in response
to nonsexual forms of body contact or excitement. The latter non predictable
erections are troublesome and may cause boys to worry and become preoccupied
with attempts to prevent or avoid inappropriate arousal. Only about half
of the boys have ejaculations before their 14th year, but most know about
them. Masturbation may increase significantly and be accompanied by guilt
if they have not been raised to know that it is normal. Nocturnal emission
or masturbation are the most common first ejaculatory experiences. Many
boys are interested in having sex with girls at 13, but are too direct
and abrupt to facilitate encounters with any but the most interested and
willing girls.

The more sexually popular boys and girls have important, gratifying
relationships with each other. Boys become more interested in selecting
girls to “go with,” even though couple dating is still a rarity. The group
is the most visible social structure, and conversation is the major group
activity. It is the fortunate 13-year-old who has an opposite sex confidant,
for he/she will have a continuing source of information on, and explanation
of, the mysteries of the thoughts and behaviors of the opposite sex. Membership
in these social groups is through peer selection, and group members usually
demonstrate above average social skills. Group membership provides opportunities
for varying levels of personal interaction and ensures continuing social
confidence and enhancement of personal understanding, sex knowledge and
relationship skills. The shy, less social children who are excluded from
group membership are disadvantaged, and this handicap is compounded by
their inability to practice socio-sexual skills. They develop compensatory
avenues of self-expression and may distinguish themselves and gain positive
recognition, or they may satisfy their need for peer recognition and acceptance
through asocial behavior and associations. Thirteen is a year of final
division between childhood and adolescence. Thirteens have passionate interests
and may put away their childhood books and toys. Their rooms are usually
unkempt, but begin to depict their personality as they plaster posters
and pictures on the walls. Their clothes are self-selected and reflect
their self-image. The telephone is more important to them than the TV,
and the radio or stereo may signal their presence. They like sports and
physical activity, and physical education may be their favorite subject
at school. Boys like to play contact sports with girls, and basketball
is a favorite, probably because it is constant activity. Thirteens are
extremely critical of their parents, especially their mother, and make
frequent derogatory comments suggesting she is a product of the Dark Ages.
Many 13s like to read, with comics giving way to romance, mystery and sports
books and magazines. Thirteens usually travel with a friend or in groups;
and often they will meet up at the movies. Girls especially identify with
movie characters and try not to cry or be scared in movies, but are often
unsuccessful at controlling their emotions. Thirteens exchange pictures
and carry them in their wallets. Boys and girls may also exchange tokens
of commitment and relationship. Thirteen likes to feel independent, resents
authority and is insulted if treated like a child. It is not uncommon for
parents and family to need a vacation from their 13-year-old, and it's
a good age for them to go to camp or spend a week or more away from home
with relatives. Thirteens respect teachers and adults that are firm, fair
and treat them like a reasoning adult. They are quick to group up and play
practical jokes on authoritarian teachers who treat them like children.

Thirteens are ruled by a developing conscience. Although they sometimes
tell half-truths to avoid confessing misdeeds and may, for “good reason,”
cheat or occasionally steal, they almost never report the wrongdoing of
others. Squealing on others is the ultimate ethical crisis.

Age 14

Fourteen is a year characterized by fulfilling the self; and individual
instruction, guidance and counseling are important. It is an age of such
self-absorption that many child experts recommend that the ninth grade
be held in separate schools so as not to mitigate this interest in self
by the temptations to regress to younger patterns or to overextend themselves
by competing with older children. Psychology, philosophy, sociology and
astrology all provide insights to the 14-year-old who eagerly searches
for his or her future path. Sure of him/herself, capable of give and take,
14s generate a friendly, relaxed atmosphere in their peer group and the
home as well. They experience few tensional outlets and wear their bodies
well. They can listen and comprehend before responding, often with humor
and/or dramatic gestures for emphasis. Fourteens are healthy and robust
and will often continue their regular routine if they have a cold or other
minor ailment. Most girls are physically mature, with all secondary sex
characteristics near completion and menstrual cycles regular (although
many are as long as 45-50 days). Many have premenstrual symptoms (cramps,
headaches, backaches or general tension or nervousness), and menstrual
discomfort the first day causes some girls to lie down for a couple of
hours, miss a meal or take medication. Many girls report experiencing a
physical response in their involvement with boys. It may be global rather
than genital and is often confusion to the girl who is poorly informed
about sexuality. Girls may begin masturbation in response to this arousal,
many for the first time.

Boys, who tend to be maturationally a little behind girls, experience
their most rapid growth spurt at 14. It will be another year, however,
before they actually look like men. At 14, the ratio of body fat to muscle
decreases, body hair increases and darkens, sideburns elongate, voices
may crack suddenly and what appears to be hoarseness from a cold very often
remains. Most boys have ejaculated by the end of their 14th year, and most
develop a regular pattern of sexual activity after their first ejaculation.
Many are extremely modest, especially about nocturnal emissions and despite
increasing societal tolerance, many experience significant masturbatory
guilt. Sex education is needed and eagerly sought by 14-year-olds. They
now want to work out their own personal sexual attitudes and need information
to do so. They need to know and discuss the broad spectrum of human sexual
behavior. Most 14s express happiness at being themselves; and although
they might make some improvements, they would really not want to be someone
else. Most of their worries and fears are anticipatory and are resolved
when the feared situation is experienced. All in all, 14's problems are
not major. They experience some moodiness and some temper; however, their
outbursts are of shorter duration and are less emotionally devastating
than they were at 13. They have a sense of humor and philosophical outlook
which makes 14 a joy to welcome back into the family. Their dissatisfactions
about self include any departures from the perfect physical form; and most
want to be taller, shorter, thinner, prettier, bigger, etc. Boys may begin
lifting weights to attain a more manly physique, and both boys and girls
may experiment with dieting. (Bulimia and anorexia nervosa may develop
in this context.) As 14s adjust to themselves as independent individuals,
fully involved in mastering life for themselves, they periodically overextend
themselves. Their sense of time and energy is boundless, and they are apt
to over commit themselves and lose the balance required to function optimally
in all aspects of their life.

Many are out of bounds and overextend themselves in relationships. Some
14-year-old girls begin to date older boys and initiate regular partner
sex, but most 14s are still group oriented, pairing off occasionally at
parties and informal get-togethers. Pairs may be stable from party to party,
but “who likes whom” is the ongoing focus of endless conversations, with
allegiances shifting often. Boys are less interested in hobbies and more
interested in girls and social interaction, but are still unsure and may
ask a girl what she would say if she were asked to go out or may depend
on a friend to ascertain her response in advance. Going steady is not common,
and many express that “it would tie me down,” Sports are important for
most boys as a rite of passage for the most athletically talented and as
a team member and a physical test for the less adept. Sports are less important
to girls; however, the athletically talented girl may excel in her chosen
sport at this age. Fourteens are not plagued by conscience but are sensitive
to the effect of their behavior on others. They like to argue, but their
arguments do not have the do or die quality they had at 13. It is more
of a game to them to exercise their increasing ability to logically defend
a position.

Fourteen is characterized by changing social relationships. They are
better with younger siblings, self-conscious in the presence of and critical
of older siblings. Their own peer group is all important, and they have
many best friends, not just one. Friendships seem to be less determined
by similarity of interest or activity; and in fact, a 14 may be attracted
to opposites. Talk is the primary group activity, and 14s can talk out
their difficulties. Although girls are more adept in social relationships,
boys have their groups as well, characterized by exuberant humor and raucous
good times. Popular boys may choose to protect a vulnerable boy and are
better able to do so than girls who attempt a similar stance with an unpopular
girl. Boys show increasing
interest in girls and may attempt to extend casual encounters. They
mix better at parties, and girls who are chosen by a boy may begin to show
a deferent attitude. A girl may turn down opportunities with other boys
before she has been asked by the boy of her choice. Fourteen-year-old girls
often prefer older boys because they have more social poise. Parties at
this age are spontaneous gatherings of groups, with some pairing off for
private moments. Couples are fluid and change often, with little intimacy
or commitment. Their significance is more social than personal--even going
steady is a short-lived experience for most 14-year-olds. The most stable
pairs are 14-year-old girls and older boys. Reputation is important, and
friends can enhance or detract from status in the microcosm of the high
school. The telephone is the essential apparatus of adolescence, more important
than TV, even for hospitalized teens. Radio is important, with music programs
favored; and stereos and private telephones are often requested as Christmas
and birthday gifts. Music preferences and clothing styles are reliable
signatures of the developing personality. Boys interested in cars, driving
is on the rise and some develop an undeniable need to drive and borrow
cars despite the risk of accident or punishment.

The high school locker room for many 14-year-olds is their first experience
at public nudity. Most 14s manage to overcome their shyness and are quickly
comfortable in varying stages of undress. A few are so shy that they request
to be excused permanently from P.E., or some just never show up. This milieu
is especially problematic for the homosexual youngster, who may be over
stimulated by mass nudity of his or her eroticized gender. It is especially
traumatic for boys, who are more stimulated by visual imagery and whose
arousal is visible to all. Physical Education instructors need to be reminded
that to require a homosexual adolescent to take part in locker room nudity
can be every bit as stimulating as expecting a heterosexual boy to dress
and shower with the girls.

Age 15

The year 15 causes a dramatic shift in focus and energy. Fifteens withdraw
and inwardize their energy to the point that they are seen as lazy, apathetic
and unmotivated. They develop a thoughtful, serious and quiet demeanor
to set off the exuberance and enthusiasms of 14. They give attention to
detail and to the details of thought and expression to the point of perfectionism.
Their need for increasing independence causes problems at home. A Cold
War with parents is not uncommon, and open defiance is the response to
being treated like a child. They have fantasies of travel and of sex. They
are gregarious with friends and often solemn at home. They don't want to
accompany family, especially to school functions, and will often refuse
to sit with family, even at church. A same-sex best friend is their constant
companion, and this close relationship is a maturity achievement.

Fifteen is the threshold of adulthood, with independent personality
patterns being a hallmark of this age. Fifteens love or hate school. They
may be academically or vocationally motivated, or they may drop out of
school and evidence attributes of low self-esteem. They may become delinquent,
and there are easily definable stratified groupings in every high school.
Self-confidence and self-esteem may become their major problems and are
related to sexual adjustment and the ability to negotiate relationships.
Fifteens need objective information about human nature and behavior. They
have high tension, may somatize their stress and may see psychiatrists
or other mental health personnel.

Girls finish off their secondary sex development, and a few stragglers
finally start their periods. Periods are regular, and most girls have premenstrual
symptoms and moderate to severe cramping with the onset of menstruation.
Boys are finishing up their secondary sexual development. The genitals
are adult size, body and facial hair show adult patterns and configurations,
they reach 95% of their adult height and their body is in better balance
and proportion. By age 15, most boys have established a regular pattern
of sexual outlet; they have fewer erections to nonsexual stimuli and may
have fewer sex materials around, as fantasy alone is sufficient for arousal.
Their masturbatory frequency increases, and some have regular sex with
girls. Gay teens may fall in love, have sex and understand that they are
homosexual.

Management of partner sex is problematic even if the partner is willing.
Where and when to find a private place for a sexual encounter is a major
concern, as are birth control and venereal disease protection if they are
sexually active with a number of partners. Most girls are worried about
reputation and fear being found out, but may decide to have intercourse
if they are in love, if they trust the boy and if the relationship seems
secure. Boys, experiencing the sexual urgency of adolescence, attempt to
persuade, manipulate and coerce girls into actual coitus. “If you love
me, you will let me put it in,” “if you don't, someone else will” and “if
you let me put it in, I'll pull out in time,” are dilemmas the mid adolescent
girl is called upon to deal with as she negotiates the relationship or
potential relationship that affords her social status and a sense of personal
worth. Girls have been raised to understand the importance of the primary
relationship and to feel responsible for maintaining it. Now they must
deal with the needs, expectations and requirement of the boys who are the
necessary other half of the dyad. The culture says, “if you're easy and
give them what they want, they will leave you.” The boys say, “if you don't
give me what I need, I'll have to find someone who will.” It is a social
dilemma. Actually, coitus with a mid adolescent boy is rarely the event
of a young girl's life. Reminiscent of stories of wedding night disappointments,
boys tend not to last long enough or be cognizant enough of their partners
to provide the ultimate experience. They want sex, often become angry and
disgruntled if it is withheld, and girls may fall quickly into a pattern
of duty sex. Adolescents who delay intercourse and establish patterns of
effective petting become more creative sex partners. Boys learn to last
longer, and girls are more apt to become reliably orgasmic with their partner
if foreplay is extensive (Hamilton, 1978)

Girls who only date occasionally may find it easier to delay intercourse;
however, some girls use sex in their attempts to secure a steady boyfriend.
Boys who don't go steady may have fairly regular partner sex with these
girls who have established a casual sex pattern. Some boys just “go for
it with every girl,” often to the amazement of their peers, and develop
socio-sexual skills that assure them an increasing number of interested
partners. Sexually naive girls may be inordinately attracted to these entrepreneurial
boys and may eagerly contribute their virginity in the process (virginity
usually does not become a burden until late adolescence).

Fifteen-year-olds are followers and can get in trouble with the proverbial
bad companion. Fifteens are prone to worry about others, friends and family
and the world. They have interest in a depth of things that touch their
life (e.g., race, religion and sex). They write reports and term papers
and debate or organize panel discussions on topics such as prostitution,
homosexuality and pornography. Fifteen-year-olds want to be free to come
and go at will and to answer to no one. Their uncommunicativeness about
their comings and goings causes parents to worry about involvement in sex
and drugs. Fifteen-year-olds take offense at this parental paranoia, even
if they are not involved in these activities. They have an ethical sense;
their conscience bothers them if they don't live up to their own standards.
They can err out of ignorance and will try to get away with things that
they know are disapproved of (usually behaviors that are reserved for elders,
such as R-rated movies, pornography, sex, smoking, drinking, etc.). They
can accept blame, but will argue the point if they feel that the restrictions
are undue. Church attendance is fairly low at 15, and some who have gone
to church all their lives drop out of regular church attendance at this
point. Some youngsters who have not had regular church attendance heretofore
begin to attend for the first time during their mid teens. There is security
in the church's strict attitudes about sexuality, and many adolescents
attempt to make sexual decisions through religious guidelines. Mature 15-year-olds
may feel doubly constrained at this age because they are ready to have
many things that are reserved for 16-year-olds, such as partner sex, driving,
independence, privacy, etc. In terms of sexual behavior, necking and petting
are the chief activity in the heterosexual couples, with more than half
the boys and two thirds of the girls reporting that they are still virgins.
(See more recent statistics for these numbers. Ed.)

Age l6

Sixteen is pre adult by law and custom. They respond to the expectations
of law and society and seem more grown-up in every way. They are characterized
by self-assurance, a sense of independence and social poise. The group
is still important, with increased pairing for longer periods of time.
Driving is a reality, and most couples have access to a car. Family relationships
are improved, but friends continue to be more important. A 16-year-old
may seek consultation from parents if problems arise; usually, boys will
consult their mothers. Some girls may prefer their fathers unless he is
entrenched in a double standard and attempts to unduly restrict their freedom.
Both boys and girls expect to marry eventually, with girls more positive
about the details. Few boys say they do not intend to marry. Both look
for partners with intelligence, job skills, good temperament, stability
and reliability. Girls stress love and interpersonal relationship skills.
Sixteen has him or herself well in hand and takes a broad and philosophical
view of things. They are tolerant of differences in others, and they can
hold their own ethical position without condemning those who differ. Sixteens
are concerned about the individual effort needed to succeed and can hold
themselves apart even from the group by which they are defined. Sixteens
usually have a fairly even disposition, they control their feelings and
check their own negative judgments of others. They are independent and
rarely abuse appropriate freedoms. They tend to treat themselves as an
equal in relationships with adults, and they try hard to be what they have
decided they want to be. Often, they are their best selves.

Sixteen's health is good. Their major complaint is acne and for some
girls, menstrual cramps. Boys finish off their pubertal development; most
shave at least once a week, and some sprout chest hair. Height is about
98% complete, and they have a firmer physique, especially those boys who
are athletically active. Sixteens are interested in work, money, clothes,
cars, music, sex and drugs. Boys' interest in girls increases; and although
graphic sex materials are still used, fantasy alone is a reliable and increasing
method of initiating the male sexual response cycle. Masturbation continues
to be the major sexual outlet for most boys; however, kissing and mutual
masturbation are favored activities of even informal pairs. Many girls
and some boys at this age feel they “are not ready” for sexual intercourse,
but few can explain their criteria of readiness. Girls fear pregnancy and
their reputation. Birth control is a management problem, especially if
they are reluctant to engage their mother's help. Some young couples go
to a clinic together to select a birth control method, which reassures
the girl's fears of security, reputation, etc.

More boys are interested in relationship sex, see girls as equal partners
and want the security of going steady. Boys press for intercourse and greater
sexual diversity. There are fewer foraging boys, but there are more girls
looking for recreational sex than in times past. Both boys and girls are
attracted to casual sexual opportunity and feel restricted by sexual commitment
in a relationship. They use the term “cheated on” and feel that it is wrong
to have sex outside of a committed relationship. There is a characteristic
pattern of breaking up and reconciling in relationships, which exemplifies
the freedom versus security dilemma of mid adolescence, but both partners
believe they should at least try to be honest in their relationship.

Cars give sexual privacy, but many 16s have sex at home, especially
if both parents work. Some parents who value their own sexuality and acknowledge
the adolescent need to be sexual, endorse sex at home for their teenagers.
Adolescents are disturbed if during their teen years, their parents' marriage
fails and they are called upon to deal with a dating parent. In sexually
committed relationships, problems develop; boys usually want sex more than
girls, and they pressure a girl to have sex when she doesn't want it. Boys
ejaculate too fast, may not effectively stimulate their partner to orgasm
and deal with the age-old problems of jealousy and possessiveness. Management
of an adolescent's sexually active lifestyle is so complicated, (e.g.,
the decision to have sex, finding a time and place, fear of being caught,
fear of pregnancy, no one to confide in, etc.), that there is little or
no time spent, or help with, learning sexual skills or becoming good sexual
partners. Couples who agree not to engage in intercourse but who continue
mutual masturbation may become highly skilled in foreplay, including oral
sex; however, girls who, for one reason or another, refuse to have intercourse
often accept oral sex as the forced choice between coitus and resent their
involvement in it.

The concept of “sweet 16, never been kissed” is nostalgia rather than
reality. There is a growing number of stable pairs at 16 that are characterized
by good grades, extra-curricular involvement, cooperative attitudes at
home and school, responsible behavior, part-time job and/or athletics and
regular partner sex with the use of effective birth control. It may well
be that the security needs formerly met at home (family of origin) are
being shifted in mid adolescence toward the intimate bonding of the future
(family of choice). Even though autonomy is virtually impossible at this
age, it is well to remember that in the first half of the 20th century,
it was possible at 15 or 16 to marry and support the family of choice independently.

Boys at 16 have a stronger tribal sense than girls of the same age.
They are more competitive with male peers and seek status by achieving
acceptance and recognition from older boys and men. They want money, a
car, power at school (student government, athletics, special skills or
talent, etc.) and a girlfriend. The girlfriend is a status symbol and signifies
success in the sociosexual arena. She is important, but not as important
to him as he is to her. Both boys and girls have to succeed with the boys.
A male high school senior explained, “girls are status and security, but
they can be more trouble that they are worth. If you really want to make
it, you have to spend a lot of time with the guys. Girls can hold you back
because you have to be on your best behavior and you have to take care
of them. You can be crazy and gross with your friends. You can talk about
sex,
race your car, stay out all night, play practical jokes, learn to drink
and dope with the guys and everyone takes care of himself. You just can't
feel free with a girl; it's too much responsibility.”

Sixteen-year-old boys want a girlfriend to take to the dance because
going stag is its own form of sociological torture, but they want to go
out drinking with the big boys: “as soon as you get your car, you try to
find someone who can buy” (liquor).

Dating a popular girl is instant status for a boy, but she is expected
to “be there,” to wait, to come down on the field after the game, to understand
when other things take priority. If she becomes possessive and demanding,
the relationship is in jeopardy because the boy loses status if he is controlled
by a girl. Having a steady boyfriend who has status among his peers is
status for a girl. She is considered fortunate if she does not have to
worry about a date for important school occasions or for Friday and Saturday
night. Attractive, popular, achieving girls who are involved in school
affairs, have a job and a car, etc., but who do not have a boy friend,
devalue themselves in comparison with less talented girls who are able
to acquire and maintain a steady relationship. To anxiously wait to be
asked to important school events and/or to miss going because no one asked
you is a painful adolescent experience. This situation may occur for girls
who are so attractive or smart or active that boys assume they are taken
or that they would not be interested in them, as well as for girls who
fall low in the sexual marketplace because of inadequacies.

Girls who are considered “one of the boys” may also have problems with
the cultural values of the high school. These girls may be every boy's
best friend and confidant. Girls who are comfortable with boys, who don't
hassle them with unwanted expectations and who accept them as they are
may not develop the socio-sexual skills needed for the friendship to become
a dating relationship. These girls may even have sex with boys and still
be considered a best friend, not a “lover” or a
“date.”

Although there are many patterns and variations, it is evident that
sex is much more complicated than function and skill. Sexual needs, gratification
patterns and experience are the expressions of the total self and are intricately
woven through the fabric of life as a whole.

PART III

Editor's Note: The current DSM-IV has the same code, and additional
information on these disorders.

DSM III and Psychosocial Disorder in Childhood

The Diagnostic and Statistical Manual of Mental Disorders, Third Edition
(DSM-III), divides psychosexual disorders into four groups. Gender
identity disorders are characterized by the individual's feelings
of discomfort with an inappropriateness about his or her anatomic sex and
by persistent behaviors generally associated with the other sex. Paraphilias
are characterized by arousal in response to sexual objects or situations
that are not part of normative arousal activity patterns and that, in varying
degrees, may interfere with the capacity for reciprocal affectionate sexual
activity. Psychosexual dysfunctions are characterized by
inhibitions in sexual desire or the psychophysiological changes that characterize
the sexual response cycle. Finally, there is a residual class of other
psychosexual disorders that has two categories: ego dystonic homosexuality
and psychosexual disorders not elsewhere classified.

The only category specifically related to children is 302.60, Gender
Identity Disorder of Childhood

The diagnostic criteria for this category for females is:

A. Strongly and persistently
stated desire to be a boy or insistence that she is a boy (not merely a
desire for any perceived cultural advantages from being a boy).

B. Persistent repudiation
of female anatomic structures, as manifested by at least one of the following
repeated assertions:

1. That she will grow up to become a man (not merely in role).
2. That she is biologically unable to become pregnant.
3. That she will not develop breasts.
4. That she has no vagina.
5. That she has or will grow a penis.

C. Onset of the disturbance
before puberty.

The diagnostic criteria for males:

A. Strongly and persistently stated
desire to be a girl or insistence that he is a girl.

B. Either one or two.
1. Persistent repudiation of male anatomic structures as manifested by
at least one of the following repeated assertions:
a. That he will grow up to become a woman (not merely in role).
b. That his penis or testes are disgusting or will disappear.
c. That it would be better not to have a penis or testes.

2. Preoccupation with female stereotypical activities, as manifested by
a preference for either cross-dressing or simulating female attire or by
a compelling desire to participate in the games and pastimes of girls.

C. Onset of the disturbance
before puberty.

Paraphilias

The essential feature of disorders in this sub-class is that unusual
or bizarre imagery or acts are necessary for sexual excitement. Such imagery
or acts tend to be insistently and involuntarily repetitive and generally
involve either 1) preference for use of a non human object for sexual arousal,
2) repetitive sexual activity with humans involving real or simulated suffering
or humiliation or 3) repetitive sexual activity with non consenting partners.
Since paraphilic imagery is necessary for erotic arousal, it must be included
in masturbatory or coital fantasies if not actually acted out. In the absence
of paraphilic imagery, there is no relief from erotic tension; and sexual
excitement and/or orgasm is not attained. The imagery in a paraphilic fantasy
(rape, S&M, bestiality, etc.) or the object of sexual excitement in
a paraphilia is frequently the stimulus for sexual excitement in individuals
without psychosexual disorder. Paraphilic imagery or the use of objects
would be considered normative in childhood masturbation sexual patterns
because of children's limited sexual knowledge and options. In that regard,
fetish behavior is not included as a diagnosis in childhood. Before the
onset of post pubescent partner sex, the criteria of “repeatedly preferred”
(to partner sex) is not assessable; and when masturbation is the only sanctioned
or available sexual option, the use of inanimate objects to enhance the
experience is common. When other options (partners) are sanctioned and
available, the “exclusive or consistently preferred” use of inanimate objects
is considered a fetish.

Although the age of onset for fetishes is in childhood or adolescence,
paraphilic attachments of childhood and adolescence may recede in their
importance or degree of dependency when other sexual options become available.
For example, the panty fetish (one of the most common) may begin in childhood
as a young boy stimulates himself with thoughts of, procurement of and
masturbation with or into female panties. However, the adult obsession
with collecting panties for sexual use, accompanied by diminished erotic
response to partner sex, is not necessarily the eventual result of this
early childhood fixation. The adult transition to gratifying partner sex
may be smooth and uncomplicated, with childhood sexual patterns giving
way to appropriate adult patterns as increasingly varied sexual options
and opportunities become available. The adult male's interest in panties
as a sexual stimulant may remain, but may become less important in the
overall adult sex pattern. Fantasies about panties as a part of sexual
arousal and/or masturbation, the purchase of panties as a personal gift
to the partner, requesting the partner to wear panties as a part of sexual
foreplay, etc., may not be considered a fetish because it is not the consistently
preferred, necessary or exclusive sexual pattern.

Sometimes a young boy's erotization of panties leads him to public behavior
that is socially unacceptable. Stealing panties from family members or
from clotheslines and peeping, especially in the windows of neighbors,
may bring a child to the attention of the police or mental health professionals;
and treatment is required. The behavior is asocial and may be obsessive,
but the diagnosis of fetishism is still premature: This and other asocial
behavior such as public exposing of genitalia, may or may not be accompanied
by a mental disorder; and a differential diagnosis is imperative. Given
the contradictory and confusing way that Western culture handles sexual
development, it is erroneous to assume that asocial sexual acts of children
are vis-a-vis
characterological pathology.

Psychosexual Dysfunctions

Psychosexual dysfunctions, characterized by inhibitions in sexual desire
or the physiological changes that characterize the sexual response cycle,
are undiagnosable in children, although there is reason to assume that
they may be manifest. There is no help for children who have developmental
sexual problems (e.g., arousal, orgasm, pain, guilt, low sensation, etc.).
Lack of knowledge and misunderstanding is a major problem, and most children
and adolescents worry about being normal. What is still lacking in any
shape or form in childhood is an open discussion about sexual anxieties,
sexual expectations, different sexual acts and feelings about sex. In one
study, 33% of girls (14-18) were not sure if they had an orgasm because
they had no idea what it was supposed to feel like. Most post pubescent
adolescents masturbate, but the majority feel guilty, ashamed, dirty, stupid,
embarrassed or abnormal after the act (Hass, 1979).

Although are no studies on sexual dysfunction in childhood, retrospective
sex histories of adults and case histories of children in psychotherapy
suggest that all is not well. We have underestimated the significance of
sexual interactions and fantasies in childhood. Until we better understand
the development of the erotic response through childhood and adolescence
and until normative behavior gradients are established, children's sexual
needs will not be properly addressed by the mental health community.

Ego Dystonic Homosexuality

Undesired homosexuality is undiagnosable in childhood. Although many
adult homosexuals retrospectively identify indications of their adult orientation
in childhood events, same-sex experimentation in childhood is a common
experience in the sex histories of heterosexual adults. It is well to remember
that homosexuality is a behavior which is dependent on the preference of
same-sex partners. The adolescent discovers and defines the elements of
sexual attraction, unique and individual to him/herself as an ongoing process
of differentiation. The homosexual discovers that s/he is sexually excited
by same-sex stimuli in the same way that the heterosexual discovers that
s/he is excited by opposite sex stimuli; and within these categories, they
both discover even more specific attractants (e.g., body types, body parts,
sex acts, positions, odors, words, etc.). It is possible for a homophobic
adolescent to be disgusted with his or her feelings of attraction to same-sex
peers and to fear the consequences of a Gay life; however, ego dystonic
homosexuality would rarely be diagnosed before early adulthood. We have
come to understand that even the most serious love affair with a same-sex
partner may not be generalized to an ongoing same-sex attraction; thus,
adolescence is too early to make a definitive diagnosis. The lack of child
sex syndromes described in DSM III does not mean that children and adolescents
are free from sexual problems or that clinicians are not consulted about
the sexual behaviors of children and adolescents. Sexual problems of children,
as seen on an out-patient basis by mental or physical health care professionals,
are usually public or semi-public behaviors that cause adults (usually
the parent) embarrassment and concern because they are a departure from
society's expectations. There are many sexual events and/or behaviors that
cause children to be referred for psychological evaluation. The parents'
decision to seek professional consultation is the solution to their feelings
of worry that the child is not normal, fear that if they don't intervene,
the child will grow up to be a sexually deviant adult, doubt that they
have the knowledge or skill to change the behavior pattern and guilt that
they have caused or contributed to the undesirable behavior.

Gender Identity Disorder in Children with Normal Genitalia

Gender Identity Disorder (GID) is a persistent belief that one's gender
has been wrongly assigned and a persistent repudiation of one's assigned
anatomical gender. In children, it is often confused with homosexuality;
and parents seek diagnosis and treatment for their child in response to
symptoms of opposite sex mannerisms and behavior. Their concerns include
embarrassment to the family members, stigmatizing of the child and potential
homosexuality. Actually, the adult manifestation of GID is transsexualism,
expressed as the feeling of being trapped in the body of the opposite sex.

Gender Behavior Disorder

Gender behavior disorder in children (mostly males) is characterized
by cross gender or androgynous behavior that is learned and reinforced
by the environment rather than being linked to a persistent belief that
they are, in fact, the other sex. The adult manifestation of GBD is transvestism
and effeminate behavior. It is important to differentiate GID from GBD
in the diagnostic process. The child who believes s/he is wrongly assigned
suffers from chronic and severe cognitive dissonance, whereas children
who know their anatomical gender but who enjoy androgynous behavior will
suffer only if the environment is punitive and non supportive. Sexual reassignment
of children is considered only in cases of gender dysphoria or non-specific
amorphous genital structure. A GID adult with normal genitalia might request
gender reassignment surgery as a matter of choice.

Excessive or Compulsive Masturbation

Masturbation frequency is highly variable in an individual child, as
well as between children. Although normative frequency data for specific
ages is unavailable, children are often referred to clinicians for excessive
or compulsive masturbation. This is a subjective quantification taken to
mean that the child is preoccupied with masturbatory activity to the exclusion
of other age appropriate pursuits and/or that the scope of the masturbation
activity is resulting in stigmatizing censure from others that may create
secondary adjustment problems for the child.

Sexologists believe that masturbation is a viable sexual activity throughout
the life span and that it need not be considered a poor post pubescent
substitute for sex with a partner. Research in female sexuality (Hite,
1976) and the treatment of anorgasmia in adult women (Barbach, 1975; Chapman,
1977; Dodson, 1974) suggest that masturbation to orgasm is an important
developmental step and possibly, a prerequisite to becoming reliably orgasmic
in adult partner sex. It is often a treatment of choice for male and female
sexual dysfunction (Kaplan, 1979) and is reported as a childhood activity
of some importance by most adults (Hass, 1979; Hite, 1976, 1978; Kinsey,
1948, 1953).

Sexologists suggest that young boys be encouraged to prolong the arousal
stage of their masturbation so as not to condition a rapid stimulus response
bond between erection and ejaculation. Young girls should be encouraged
to look at and identify their external genitalia and to connect their erotic
feelings and sexual response cycle to appropriate genital body parts along
with others they might already have. Parents need to understand that childhood
masturbation is a normal and beneficial behavior that needs to be managed
to coincide with social etiquette.

Precocious Sexual Interest and Behavior

Clinicians are often consulted by parents who are anxious about their
child's interest in sexual topics, masturbation or sex play with siblings
and peers. If the child's basic interest in sex is complimented by unsupervised
opportunity to engage in trial-and-error learning with a partner, sexual
rehearsal play is predictable. Some sexologists suggest that not only is
sexual rehearsal play quite predictable in children, it is advisable and
should be encouraged in order to forestall adult sexual problems (Money,
1975; Yates, 1978).

Intense and continued or intermittent sexual interest in children should
be accommodated as any other interest would be. Age appropriate books and
conversations with parents endorse the child's curiosity about this important
part of life and encourage an open and unashamed quest for sexual knowledge.
In contrast, a child who shows little interest or curiosity about sex should
not be overwhelmed with sex information by over-zealous parents. Some children
personalize their sexuality very early and are uncomfortable with candid
sex conversations. They appreciate appropriate sex materials to be used
in private and occasional one-on-one talks with a parent to clear up any
troublesome sexual ideas or feelings. A few parents may worry about a child
with low sex interest, but lack of sex interest is more often considered
normal in children. Of greater concern is the child who is very public
with sex talk and sex play, masturbation with self or with peers. Parents
are concerned that the child is abnormal genetically or hormonally, that
s/he will be censured by other adults and children, that his/her sexual
behavior will reflect badly on siblings and family, that s/he will be a
target for sexual abuse or exploitation by adults or that s/he will grow
up to be promiscuous or perverted.

Three-year old D was a highly sexed boy who had been involved in sex
play with age mates and an older child. He asked his therapist if she wanted
to put her mouth on his “dinky.” When she replied in the negative, he pleaded
“you'll like it,” “I'll pay you money,” “I'll be your best friend.” When
asked if he liked to “play dinky,” he frowned menacingly, clenched his
fists and aggressively replied, “yes, I like it, and I'm not going to stop!”

Children who are pseudo-mature in any sense are special children with
special needs. They demand more from parents and may be considered a blessing
or a curse, depending on the value system and resources of the parents.
Intellectual genius, superior athletic potential and exceptional musical
talent are all considered valuable gifts that should not be wasted. The
child who is sexually precocious in development or interest is, in contrast,
shunned and pitied. The parents of these children need help, not only in
the management of the child's behavior, but also in considering that precocity
in this area need not be thought of as an affliction.

Children Who Report Sexual Contact with an Adult Which Cannot Be
Substantiated

Psychological literature and the popular press report and often sensationalize
the plight of the traumatized child whose story of sexual activity with
an adult is not believed and, conversely, of the victimized adult who steadfastly
denies the sexual accusations of a child. The most commonly reported pedophilic
situation is that of the adult male and the prepubescent female. This is
not to say that sex between an adult female and a prepubescent male does
not occur, but it would probably not be reported; and if it were, it would
probably not be considered a traumatic experience for the child.

In Western culture, there is a time-honored tradition of young boys
being sexually initiated by an experienced older woman. Girls, in contrast,
are considered permanently damaged by early sexual initiation by an adult
male. The society's attitude that the child has been damaged by a sexual
experience is extended to boys only if the sexual encounter is homosexual
or if residual physical damage is sustained. Sexual behavior between an
adult female and a female child is the least reported pedophilic possibility
and is of least interest to law enforcement and the community at large.

It is difficult to generalize about adult/child sex because of the variability
of age and sex in any individual case. It is important to note that if
the sexual encounter occurred and if it was traumatic for the child, the
diagnostic process with a clinical child sexologist is therapeutic. Psychotherapy
consists of talking about traumatic situations in order to bring the experience
into cognitive awareness and to work through the feelings engendered by
the event. Properly handled, a sexual trauma is no exception to this process.
A client is ill served by a therapist who feels that the child has been
permanently damaged by the experience and relates to him/her as a victim.

Many adult women have reported satisfying non traumatic prepubescent
incestuous relationships from which they graduated to post pubescent sex
with peers without undue incident. In contrast, many patients in psychotherapy
report unresolved conflicts in association with childhood sexual experiences;
and there is some evidence to suggest that the greater the age differential
between participants, the greater the potential for trauma. It is important
to note that most reported pedophilic sex is incestuous and that incest
is a family rather than an individual pathology.

Post-pubescent Sex with a Partner, Heterosexual

Sexologists have attempted to deal with the question of sexual readiness
in terms of chronological age; and there is a reasonable consensus that
around the age of 16, adolescents are physiologically and psychologically
ready. The older adolescent is interested in forming primary relationships
outside the nuclear family, and sexual sharing is an integral part of these
relationships.

Sexuality is a major concern of adolescence; and in that regard, adolescents
are poorly served by the professional community, the family, the school
and the culture (Hass, 1979).

The professional mental health worker sees a small fraction of adolescents
and may or may not address sexual issues. Family members have little credibility
in sexuality if the foundation was not accomplished in childhood. The school
is still concentrating on reproductive biology and venereal disease, while
the adolescent needs help with socio-sexual issues. The culture simultaneously
stimulates and misinforms, encourages and prohibits, punishes and rewards
the adolescent for sexual interest and behavior.

The revered notion that sex is natural, happening with style, sensitivity
and spirituality when two people love each other, is a myth that significantly
departs from most reported first encounters. It does however, perpetuate
a rationale for those who oppose real sex education and dooms the teenager
who is misinformed by the exploitive messages of the marketplace.

Post-pubescent Sex with a Partner, Homosexual

Increasingly, counselors and therapists are consulted when parents suspect
or know that their adolescent is in love with a person of the same sex.
Even though societal attitudes are relaxing and homosexuality is no longer
a disease category in the APA DSM-III, for the individual family, it is
a major trauma. Professional consultation is sought by the parent with
the initial purpose of curing the errant behavior, but the family system
is the actual patient or client. Both parents and child need to know that
a same-sex love affair does not automatically mean that either participant
has a homosexual orientation or that a heterosexual love affair guarantees
a heterosexual orientation. It may be that the love object happens to be
of the same sex, but the love feelings are unique to that individual and
may not be generalized to others of the same sex. Perhaps a bisexual resolution
will occur, with either or both sexes being available as primary partners
throughout a specific life phase or across the life span. Additionally,
the first same-sex love may be the expression of an exclusively homosexual
life pattern to come. It is well to keep in mind that the child is doing
what comes naturally. Children experience their erotic and love feelings
in association with certain people and events and not in association with
other people and events.

Occasionally, an adolescent will seek consultation about homosexual
feelings or experiences without parental knowledge. A few adolescents are
totally unaccepting of homosexuality and are repulsed by any same-sex attraction
they might feel. They are traumatized by a same-sex approach or experience,
even though they may have been a willing participant. They seek professional
help to get rid of whatever is causing their attraction to and by members
of the same sex.

Most parents fervently hope that their child's same-sex preference is
a phase they are passing through, and they are unwilling to disown their
homosexual child. Some families or individual family members may be unwilling
or incapable of accepting homosexuality, thus precipitating the Gay adolescent's
premature emancipation from family.

Sexual Concerns of the Physically and Mentally Disabled

The myth of the sexual innocence of childhood is most secure in the
homes of the disabled child. Close parental supervision, limited autonomy
with peers, identity as a physically disabled child or child with special
needs and rejection by peers as a potential sex partner all contribute
to the negation of sexuality of the physically or mentally disabled child.
Disabled children have sexual curiosity and sexual feelings. Despite the
conspiracy of silence, they need basic sexual knowledge and information
regarding how they can be sexual, given their specific limitations. As
adolescents, they need opportunities to experience their sexual response
cycle, to learn what their individual sexual limitations and abilities
are and perhaps, more importantly, how to negotiate for sex with a partner,
especially the orthopedically handicapped, who are assumed to be incapable
of being sexual by most non disabled people.

A physically healthy child with mental retardation poses another type
of problem. They may be quite normal in physical and sexual development
and as an adolescent, may be attractive enough to be selected as a potential
sex partner by a peer or an adult. Impaired mental function may, however,
disallow good judgment in sexual situations. Their own sexual desire, coupled
with this lack of discrimination, makes them an easy target for sexual
exploitation. The mentally retarded child needs explicit sex education;
reinforced, plainly stated rules about socio-sexual conduct; adequate supervision
and effective birth control at the appropriate age.

Families of disabled adolescents who live at home and caretakers of
institutionalized teens, need to facilitate the sexual opportunities of
their charges. Even if s/he can acquire potential partners, the disabled
adolescent needs a safe place, privacy and, perhaps, some physical assistance
to have a successful sexual experience. The issues of birth control and
paid partners are complicated for adolescents or young adults in institutions
or on public assistance, as charges for these services are not reimbursable
by third party payers. As a society, by default, we have decided that the
disabled shall not have sex lives. The advocacy groups for individuals
with special needs have not provided or demanded sexual equality and sexual
rights, which, for many disabled people, are as important as access to
public buildings or the Special Olympics.

Sexual Guilt as a Factor in the Treatment of the Hospitalized Child

Psychological services for the child hospitalized on the medical or
surgical ward have become standard practice in many hospitals. In both
routine ward service and psychological referrals, the alleviation of sexual
guilt with regard to masturbation is often a significant factor in the
understanding and treatment of the physical illness. From the concrete
thinking of the young child to the maturing moralism of the teenager, the
cause-and-effect rationale is predominant. The simplistic link from bad
thoughts to bad deeds usually includes the forbidden sexual behaviors.
A frank discussion about masturbation, what it is and what it isn't, allows
the therapist to assuage the child's guilt about masturbation, to demythologize
and disconnect sexual behavior as the
cause of the injury or illness, to impart accurate information and
to give permission for continued masturbatory behavior in the hospital,
helps to facilitate trust in the therapist about these personal concerns
and others (e.g., recovery, abandonment, death, etc.).

Most adults are ambivalent about children's masturbation. Medical and
hospital personnel may need some help in understanding the purpose of dealing
with masturbation when health concerns are primary. Masturbation is an
effective tension- and anxiety reducer in children and adults, and it is
self affirming. It is an activity that reclaims the body and offsets intrusive
hospital procedures. The cessation of a regular masturbation pattern constitutes
an unnecessary deprivation and added stress to an already stressful situation.

Child Prostitution and Kiddie Porn

The exploitation of children is an anathema in our humanitarian society.
We have laws to protect children from unscrupulous adults; however, there
is a societal reluctance to intrude on the autonomy of the nuclear family.
The campaign for the recognition of the battered child as a syndrome of
ongoing abuse was hard-fought in the 1960s. No one wanted to believe or
admit that it was a widespread phenomenon that had crossed all educational,
socioeconomic, racial, ethnic and religious lines.

Child prostitution and kiddie porn are similarly societal problems that
adults are trying hard not to address. Runaways who become street children,
with no jobs (many are too young to work legally), no money, no shelter,
etc., quickly learn that they have only one negotiable commodity-- their
sexuality. Male or female, they can sell their bodies to adult men. Although
the ranks of street children relegated to prostitution and other forms
of sexual exploitation grow consistently, some children are encouraged
by a parent into prostitution to augment the family income and upgrade
the standard of living of mother and siblings. These children are usually
female, living with a mother as a single parent. Girls in this situation
are more apt to come to the attention of authorities and be referred for
evaluation and therapy than street children, who are rarely seen professionally.
Any individual can be psychologically evaluated and can benefit from the
self-knowledge gained in psychotherapy; however, child prostitution and
kiddie porn are broad spectrum societal problems that will not be alleviated
by individual psychotherapy.

Other Symptoms of Sexual Significance

Peeping Toms, stealing underwear and sex with animals are asocial and
illegal activities which may be transient attempts to satisfy child or
adolescent sexual curiosity, or they may be the development of aberrant
patterns of voyeurism, fetishism and bestiality. The behavior may be in
response to a lack of knowledge or an expression of underlying psychopathology.
It is helpful to the child if the differential diagnosis is made by a therapist
who doesn't over-react to the symptoms. It is well to remember that society's
messages about sex are contradictory and confusing to children and adolescents.
Whether the resultant dissonance is expressed as private worry, fear and
doubt or erupts into public behavior, children are well served by accurate
information, endorsement of the normalcy of sexual feelings and desires,
their right to be sexual and an opportunity to learn culturally acceptable
socio-sexual behavior and skills.